Pregnancy after thoracic organ transplantation: the Belgian experience.

V.A.N. Cleemput, O.V.C. van Caenegem, A. Roussoulières, C. Knoop, R. Vos, P. Evrard, A. Vorlat, A. Ancion, S. Verstreken, V. Verplancke, M. de Pauw, On behalf of Belgian Thoracic Advisory Committee (BeThAC)

Friday 16 march 2018

10:30 - 10:40h at Willem Burger Zaal

Categories: Clinical

Parallel session: Parallel session 13: Clinical

Johan Van Cleemput, Olivier Van Caenegem, Ana Rousselières, Christiane Knoop, Robin Vos, Patrick Evrard, Ann Vorlat, Arnaud Ancion, Sophie Verstreken, Veronique Verplancke, Michel De Pauw for the Belgian Thoracic Advisory Committee (BeThAC).

Aim

to summarize the Belgian experience with pregnancy after heart (HTx), lung (LTx) and heart-lung (HLTx) transplantation

Results

Twenty female recipients of thoracic organs delivered 24 children: 17 after HTx, 2 after LTx and 1 after HLTx. Their age at transplantation was 23 ± 6 years (range 12→35) and the deliveries took place 6 ± 5 yrs (1→17) after transplantation.

The reason for HTx was congenital heart disease (n=7), dilated cardiomyopathy (DCM, n=9) and ARVC (n=1). In 5 women with DCM there was a family history of DCM (fDCM) and in 3 the underlying pathogenic mutation was found. Both women that underwent LTx had cystic fibrosis (CF) and the HLTx was performed because of idiopathic pulmonary artery fibrosis (iPAH).

Children were followed for 9 ± 8 years (0→21) and all are alive. One was born with an agenesis of the nose and 1 received an HTx because of end-stage heart disease secondary to fDCM at 7 years. Three children (3, 13 and 19 years) are asymptomatic carriers of a pathogenic mutation.

The HLTx recipient unfortunately died of bronchiolitis obliterans syndrome (BOS) 2,5 years after delivery (AD). One woman with LTx had a re-LTx because of BOS 2 years AD, a renal transplantation (RTx) 9 years AD and is, 13 years AD, again BOS. The other patient with LTx is oxygen dependent because of BOS 13 years AD. All heart recipients are alive, but 1 received a re-HTx 9 years AD because of transplant vasculopathy (TXCAD), 1 is on the WL for re-HTX because of TXCAD 3 years AD. Two have symptomatic TXCAD and 3 HTx recipients received a RTx respectively 6, 8 and 11 years AD.

Conclusion

Successful pregnancy after HTx, LTx and HLTx is possible, yet experience is limited. Only one child had a serious birth defect and although all are alive, there is a serious risk of disease transmission in women with DCM, even in the absence of a family history at the moment of HTx. Not unexpectedly, transplanted mothers are prone to serious morbidity and even mortality, especially after LTx and HLTx. These findings should be clearly discussed with the couple desiring to have children, before women with an HTx, LTX or HLTx try to become pregnant.