Study links solid organ transplant to adverse pregnancy outcomes

Study links solid organ transplant to adverse pregnancy outcomes | Image Credit: © Gajus - © Gajus - stock.adobe.com.

The risks of preeclampsia, preterm birth, and low birth weight are increased 4-fold to 6-fold among pregnancies receiving a solid organ transplant, according to a recent study published in JAMA Network Open.¹

A significant increase in the prevalence of solid organ transplants has been reported over time, with 65,775 organ transplants occurring among US individuals in 2023. Of these, 9077 were kidney transplants and 3116 liver transplants in women aged 18 to 49 years.²

Pregnancy in transplant recipients has been linked to increased risks of adverse pregnancy outcomes, but this data is mostly from registry and single-center reports.¹ Therefore, a meta-analysis must be conducted to further examine this association.

To determine the link between solid organ transplant and adverse pregnancy outcomes, investigators conducted a systematic review and meta-analysis. Articles from January 1, 2000, to June 20, 2024, were identified through a systematic search of the PubMed, EMBASE and Scopus databases.

Studies with participants who were pregnant and had solid organ transplants, as well as a comparison group of pregnant patients without solid organ transplant and at least 1 primary or secondary pregnancy outcome of interest were included in the analysis. Studies reporting allograft loss or allograft rejection during pregnancy were included for the second goal.

Preeclampsia, preterm birth, and low birth weight were reported as primary outcomes. Secondary outcomes included live birth, gestational age at birth, very low birth weight, very preterm birth, and cesarean delivery.

Three authors performed abstract and full-text review, with discrepancies solved by 2 mediators. Data was extracted by 2 reviewers, with risk of bias measured using the Newcastle-Ottawa Scale.

There were 22 articles included in the analysis, encompassing a population of 92,289,079 women. A solid organ transplant was reported in 4786, 57.6% of which were among women with kidney transplants, 37.8% among women with liver transplants, 4.4% among women with heart transplants, and 0.1% among women with lung transplants.

A primary or secondary outcome was reported in 14 studies, while 13 reported the rate of allograft outcomes during pregnancy. Of studies, 6 were from North America, 2 from Australia, 11 from Europe, 1 from Asia, and 2 from the Middle East.

A significant association was reported between solid organ transplant and preeclampsia, with an odds ratio (OR) of 6.34 and adjusted odds ratio (aOR) of 6.34. Similarly, the OR and aOR for preterm birth after solid organ transplant were 7.48 and 5.31, respectively. Finally, for low birth weight, the OR and aOR were 5.50 and 4.96, respectively.

No significant association was reported between solid organ transplant and live birth. However, solid organ transplant was significantly associated with very preterm birth and very low birth weight, with ORs of 14.47 and 4.97, respectively.

For cesarean delivery, the OR was 3.67, indicating a significant association. When evaluating the link between solid organ transplant and gestation at birth, a statistically significant mean difference of -3.37 was reported.

Of allograft outcomes, 84.8% were from kidney transplants, 14.3% were from liver transplants, 0.3% from lung transplants, and 0.6% from heart transplants. A pooled incidence of 2.39% was reported for acute allograft rejection during pregnancy and 1.55% for allograft loss during pregnancy.

These results indicated a significant association between solid organ transplant and adverse pregnancy outcomes, with an overall low rate of allograft rejection and loss during pregnancy. Investigators recommended further research about immunosuppression used at conception and during pregnancy.

References

1. Yo JH, Fields N, Li W, et al. Adverse pregnancy outcomes in solid organ transplant recipients: A systematic review and meta-analysis. JAMA Netw Open. 2024;7(8):e2430913. doi:10.1001/jamanetworkopen.2024.30913
2. Organ procurement and transplantation network. US Department of Health & Human Services. Accessed September 3, 2024. https://optn.transplant.hrsa.gov/