Pregnancy in solid organ transplant recipients: An Australian quaternary hospital experience and literature review

Background Pregnancies in solid organ transplant recipients are increasing. Method This retrospective observational study aims to evaluate the management and outcomes of pregnancies in heart, lung, liver and kidney transplant recipients at the Royal Brisbane and Women's Hospital from January 2009 to December 2024. Results Thirty-four pregnancies in 25 women resulted in 29 live births, two terminations and three miscarriages. Median maternal age was 31 years. Median time from transplantation to conception was 6 years. Preconception comorbidities included hypertension (36%), chronic kidney disease (72%) and diabetes mellitus (24%). Maternal complications included pre-eclampsia (35.3%), gestational diabetes mellitus (11.5%), acute kidney injury (55.9%), permanent renal dysfunction (20.6%), infection (35.3%), caesarean section (72.4%), graft rejection (5.9%), graft failure (8.8%) and death (2.9%). Neonatal complications included preterm birth (75.9%), extreme preterm birth (10.3%), low birth weight (64.5%), small for gestational age (9.7%) and neonatal care (87.1%). Conclusion Pregnancy following solid organ transplantation remains challenging.