Outcomes and management strategies of pregnancies after heart and lung transplantation across Europe

Background: Literature on pregnancy after heart and/or lung transplantation (heart transplantation (HTx), lung transplantation (LTx), heart lung transplantation (HLTx)) remains sparse. This study assessed short- and long-term outcomes of pregnancies post-thoracic organ transplantation across Europe and analyzed center management of these patients. Methods: European centers provided retrospective data on post-HTx/LTx pregnancies and center strategies for handling transplant recipients with a pregnancy wish. Descriptive statistics and linear regression analysis were used. Results: Forty-two females had 50 pregnancies across 12 European centers. Pregnancy-induced hypertension occurred in 50% (HTx), 28% (LTx), and 20% (HLTx), and preeclampsia in 19%, 16%, and 20%, respectively. Preterm birth (<37 weeks) occurred in 23% (HTx) and 68% (LTx), and birth weight <2,500 g in 8% and 58%, respectively. Live birth rate was 98%. In multivariable analysis, a trend for higher birth weight with higher pre-pregnancy estimated glomerular filtration rate was observed (B 13.3, 95% CI −1.7-28.4, p = 0.08). Graft function remained stable in most patients during and after pregnancy. During follow-up (mean 15 years, range 5-31 post-transplantation), 6/40 mothers (15%) died (1 HTx, 2 LTx, 3 HLTx), with their children aged 0-11 years. No specific physical health problems were mentioned in 29/30 children (age 0-22 years). Physician opinions towards pregnancy differed from reluctant (31%) to positive (69%), with numerous management variations. Conclusions: We show reassuring pregnancy outcomes for post-HTx, LTx, and HLTx patients in an exclusive European cohort, despite high pregnancy complication rates. Graft function and overall maternal survival appear unaffected. We highlight differences in pregnancy management between centers and suggest development of a uniform approach.