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Thoracic organ transplantation and pregnancy outcomes: systematic review and meta-analysis

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Abstract

Purpose

Pre-conceptual comorbidities, an inherent risk of graft loss, rejection during pregnancy, and the postpartum period in women with thoracic lung transplant may predispose them to increased risk of adverse feto-maternal outcomes. The study aimed to systematically analyze and assess the risk of adverse pregnancy outcomes in women with thoracic organ transplant.

Methods

MEDLINE, EMBASE, and Cochrane library were searched for publication between January 1990 and June 2020. Risk of bias was assessed using Joanna Briggs critical appraisal tool for case series. The primary outcomes included maternal mortality and pregnancy loss. The secondary outcomes were maternal complications, neonatal complications, and adverse birth outcomes. The analysis was performed using the DerSimonian–Laird random effects model.

Results

Eleven studies captured data from 275 parturient with thoracic organ transplant describing 400 pregnancies. The primary outcomes included maternal mortality {pooled incidence (95% confidence interval) 4.2 (2.5–7.1) at 1 year and 19.5 (15.3–24.5) during follow-up}. Pooled estimates yielded 10.1% (5.6–17.5) and 21.8% (10.9–38.8) risk of rejection and graft dysfunction during and after pregnancy, respectively. Although 67% (60.2–73.2) of pregnancies resulted in live birth, total pregnancy loss and neonatal death occurred in 33.5% (26.7–40.9) and 2.8% (1.4–5.6), respectively. Prematurity and low birth weight were reported in 45.1% (38.5–51.9) and 42.7% (32.8–53.2), respectively.

Conclusions

Despite pregnancies resulting in nearly 2/3rd of live births, high incidence of pregnancy loss, prematurity and low birth weight remain a cause of concern. Focused pre-conceptual counseling to avoid unplanned pregnancy, especially in women with transplant-related organ dysfunctions and complications, is vital to improve pregnancy outcomes.

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CRD42020164020.

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Data availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

    Nivedita Jha

  2. Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

    Ajay Kumar Jha, Sandeep Kumar Mishra & Satyen Parida

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  1. Nivedita Jha
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  2. Ajay Kumar Jha
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Contributions

NJ: helped in literature search, extraction of data and preparation of final draft of manuscript. AKJ: helped in data extraction, statistical analysis, interpretation of result, and preparation of final draft of manuscript. SKM: helped in data extraction, statistical analysis, interpretation of result, and preparation of final draft of manuscript. SP: helped in literature search, extraction of data, and preparation of final draft of manuscript.

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Correspondence to Ajay Kumar Jha.

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Jha, N., Jha, A.K., Mishra, S.K. et al. Thoracic organ transplantation and pregnancy outcomes: systematic review and meta-analysis. Arch Gynecol Obstet 309, 385–396 (2024). https://doi.org/10.1007/s00404-023-07065-x

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