Pregnancy outcomes and management in lung and heart transplant recipients: A systematic review

JHLT Open Pub Date : 2025-05-27 DOI:10.1016/j.jhlto.2025.100297

Aya Tanaka , Filippos T. Filippidis , Marie Line El Asmar , Anna Reed , Andrew Morley-Smith , Vasiliki Gerovasili

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Abstract

Immunosuppression advances have enabled organ transplant recipients to consider parenthood, but pregnancy poses risks to maternal and fetal health. This systematic review examines pregnancy outcomes and immunosuppression management in cardiothoracic transplant recipients. We conducted a literature search of PubMed/Medline, Embase, and Maternity and Infant Care Database in December 2022. We identified 54 relevant studies and data from the Transplant Pregnancy Registry International, covering 404 pregnancies from 272 heart recipients (HTR) and 148 pregnancies from 121 lung recipients (LTR). Live births occurred in 74.3% of HTR and 65.5% of LTR pregnancies (22% preterm). Graft dysfunction developed in 11.5% (during) and 12.4% (after) of HTR pregnancies and 17.6% (during) and 18% (after) of LTR pregnancies. Other complications included hypertension (HTR: 36.9%, LTR: 58.8%), preeclampsia (HTR: 19.7%, LTR: 12.2%), and diabetes (HTR: 11%, LTR: 27%). Mortality was 17.4% for HTR and 26.5% for LTR. Half of HTR and two-thirds of LTR were on Tacrolimus. Common immunosuppression changes included discontinuation of Mycophenolate Mofetil, Azathioprine, or Sirolimus with corticosteroid dose adjustment. Despite high successful pregnancy rates, heart and lung transplant recipients may face substantial risks of graft dysfunction and maternal death post-pregnancy.

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肺和心脏移植受者的妊娠结局和管理：一项系统综述

免疫抑制技术的进步使器官移植受者能够考虑为人父母，但怀孕对母婴健康构成风险。本系统综述探讨了胸廓移植受者的妊娠结局和免疫抑制管理。我们于2022年12月对PubMed/Medline、Embase和母婴护理数据库进行了文献检索。我们从国际移植妊娠登记处（transplantation Pregnancy Registry International）收集了54项相关研究和数据，涵盖了272例心脏受体（HTR）的404例妊娠和121例肺受体（LTR）的148例妊娠。74.3%的HTR妊娠和65.5%的LTR妊娠（22%早产）发生活产。HTR妊娠期间（11.5%）和之后（12.4%）发生移植物功能障碍，LTR妊娠期间（17.6%）和之后（18%）发生移植物功能障碍。其他并发症包括高血压（HTR: 36.9%, LTR: 58.8%），先兆子痫（HTR: 19.7%, LTR: 12.2%）和糖尿病（HTR: 11%, LTR: 27%）。HTR的死亡率为17.4%，LTR的死亡率为26.5%，HTR的一半和LTR的三分之二使用他克莫司。常见的免疫抑制变化包括停止使用霉酚酸酯、硫唑嘌呤或西罗莫司并调整皮质类固醇剂量。尽管成功妊娠率很高，但心脏和肺移植受者可能面临移植物功能障碍和妊娠后产妇死亡的重大风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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