Annual Scientific Meeting
Introduction: Liver transplantation is a safe and effective intervention for patients with acute liver failure and cirrhosis. Given that the number of liver transplantations in women of childbearing age is increasing, it is important to recognize complications during pregnancy in these patients. Previous studies have noted an increased risk of complications, specifically hypertension and preeclampsia. This study aims to evaluate complications during pregnancy in patients after liver transplantation and the effect these complications have on patient and hospital outcomes.
Methods: Utilizing the Nationwide Inpatient Sample, a retrospective database analysis was performed on pregnant patients aged greater than 18 between 2005 and 2013. Patients were selected with the use of ICD-9 codes. Multivariable and propensity weighted analyses were used to evaluate the impact of liver transplantation on pregnancy complications and hospital outcomes including hospital length of stay and costs.
Results: A total of 38,449,030 pregnant patients were included in this study including 1,469 patients with a history of liver transplantation. Patients with a history of liver transplant were more likely to undergo a caesarean delivery and have a pregnancy related complication including miscarriage, intrauterine growth restriction, postpartum hemorrhage, hypertension during pregnancy, preeclampsia and venous thromboembolism (p< 0.001). Propensity weighted analysis revealed higher rates of pregnancy complications (OR 2.11, 95% CI 1.63, 2.73), higher cost of admission ($3,023, 95% CI 850, 5,197) and longer length of stay (1.52 days, 95% CI 0.62, 2.41) among those with a liver transplant. A subset analysis among pregnant patients with a history of liver transplantation revealed 823 (56%) of these patients suffer from at least one pregnancy related complication. On multivariable analysis, patients that experienced a pregnancy related complication had a longer length of stay (2.45 days, 95% CI 1.44, 3.45) and higher cost of admission (5,205, 95% CI 2,848, 7,561).
Discussion: Pregnancy after liver transplant is associated with higher rates of pregnancy complications and worse patient and hospital outcomes. Further studies should be completed in order to improve outcomes in these patients.