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Medical/Surgical/Diseases/Complications

Poster Session 1

(219) Pregnancies in heart transplant recipients: the impact of preeclampsia on pregnancy outcomes and graft loss

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee

    Presenting Author(s)

  • VK

    Vanessa Kirschner, BS

    David Geffen School of Medicine, University of California Los Angeles
    Los Angeles, CA, United States

    • Primary Author(s)

  • Ophelia Yin, MD

    Maternal-Fetal Medicine Fellow
    University of California San Francisco
    San Francisco, CA, United States

    • Coauthor(s)

  • LC

    Lisa Coscia, BS, RN

    Transplant Pregnancy Registry International, Gift of Life Institute
    Philadelphia, PA, United States

  • SC

    Serban Constantinescu, MD, PhD

    Lewis Katz School of Medicine, Temple University
    Philadelphia, PA, United States

  • MM

    Michael Moritz, MD

    Transplant Pregnancy Registry International, Gift of Life Institute
    Philadelphia, PA, United States

  • RI

    Roxanna Irani, MD, PhD

    University of California San Francisco
    San Francisco, CA, United States

  • Yalda Afshar, MD, PhD (she/her/hers)

    Assistant Professor
    David Geffen School of Medicine, University of California Los Angeles
    Los Angeles, CA, United States

Objective: Heart transplant recipients have an increased risk of hypertension, with a prevalence of 72% at 1 year after transplant. Pre-pregnancy hypertension elevates risk of preeclampsia, with >25% of heart recipients experiencing this complication. The impact of preeclampsia on heart transplant recipients is unknown. We describe heart transplant recipients who developed preeclampsia and the effect of preeclampsia on graft and pregnancy outcomes.

Study Design: This is a retrospective cohort study of adult heart transplant recipients with subsequent pregnancy of ≥ 20 weeks’ gestation enrolled in an international transplant registry between 1967- 2022. Primary outcome was graft loss within 2 years from delivery. Secondary outcomes included pregnancy and neonatal outcomes. Statistical comparisons were made with Wilcoxon rank sum and Fisher’s exact tests in Rstudio v.2023.06.1.

Results: 146 pregnancies and 149 neonates met inclusion criteria. All were livebirths. 42 pregnancies (28.8%) developed preeclampsia. Cardiomyopathy was the leading diagnosis for transplantation in both cohorts. Baseline characteristics of age, BMI, race, and multiple gestation were similar, with the majority self-identifying as white. The preeclampsia group had higher rates of nulliparity (81.0% vs 54.8%, p< 0.01), chronic hypertension (73.8% vs 34.6%, p< 0.01), and repeat transplant (11.9% vs 1.9%, p< 0.05). Immunosuppressant regimens were similar between cohorts; notably there were mycophenolate and sirolimus exposures in both groups (p >0.05). Incidence of graft loss at 2 years was similar with (4.8%) or without (2.9%) preeclampsia, p=0.72. Preeclampsia was associated with lower gestational age at birth (35.0 vs 37.0 weeks, p< 0.01) and lower birth weight (2310 vs 2801 grams, p< 0.01).

Conclusion: There was no difference in graft loss within 2 years from delivery in heart transplant recipients who developed preeclampsia. Risk factors for preeclampsia included nulliparity, chronic hypertension, and repeat heart transplant. These data provide pertinent information for counseling heart transplant recipients who pursue pregnancy.