Outcomes Following Pregnancy in Living Lobar Lung Transplantation

PurposePregnancy following lung transplantation has been described, but pregnancy following living donor lobar lung transplantation (LDLT) has not been reported. LDLT was originally developed to decrease transplant waiting list mortality due to a lack of available organs. As female patients with LDLT matured, physicians were faced with advising patients on family planning. Generally, most physicians recommend abstaining from pregnancy after lung transplantation due to the required alterations in immunosuppressive therapy that could increase the risk of rejection. Pregnancy following LDLT carries the additional risk of hemodynamic changes associated with smaller than normal total lung volumes. The aim of this study was to evaluate outcomes following pregnancy with LDLT.MethodsA retrospective review was conducted to identify all patients who received LDLT and subsequently became pregnant. Institutions which previously published on LDLT were contacted to identify all LDLT patients that had become pregnant. This included our own institutional results as well as those of Massachusetts’s General Hospital, St. Louis Children’s Hospital, the National Transplantation Pregnancy Registry and the experiences from Okayama, Japan and Middlesex County, UK.ResultsA total of four LDLT patients and five pregnancies were identified, all from our institution. The median age at transplant was 24 years (range 21-29). The indication for transplant in all patients was cystic fibrosis and each received bilateral LDLTs on cardiopulmonary bypass. Median left lung ischemic time was 43 min, median right lung ischemic time was 62 min and median pump time was 150 min. Median time to pregnancy was 6 years post transplant (range 1-6 years). Median gestation time was 36 weeks (range 34 to 37 weeks). Two patients suffered pre-ecclampsia, but no patient developed pulmonary hypertension or acute rejection during pregnancy. Median time from transplant to telephone interview was 17 years. No patient has developed worsening pulmonary function or acute/chronic rejection. One patient developed lymphoma which is in remission. All 5 children of these LDLT patients are well and none has cystic fibrosis.ConclusionPregnancy after LDLT is a rare event, but appears to be safe and has good outcomes in well managed patients. The complications of pulmonary hypertension and rejection may be overestimated in this population. PurposePregnancy following lung transplantation has been described, but pregnancy following living donor lobar lung transplantation (LDLT) has not been reported. LDLT was originally developed to decrease transplant waiting list mortality due to a lack of available organs. As female patients with LDLT matured, physicians were faced with advising patients on family planning. Generally, most physicians recommend abstaining from pregnancy after lung transplantation due to the required alterations in immunosuppressive therapy that could increase the risk of rejection. Pregnancy following LDLT carries the additional risk of hemodynamic changes associated with smaller than normal total lung volumes. The aim of this study was to evaluate outcomes following pregnancy with LDLT. Pregnancy following lung transplantation has been described, but pregnancy following living donor lobar lung transplantation (LDLT) has not been reported. LDLT was originally developed to decrease transplant waiting list mortality due to a lack of available organs. As female patients with LDLT matured, physicians were faced with advising patients on family planning. Generally, most physicians recommend abstaining from pregnancy after lung transplantation due to the required alterations in immunosuppressive therapy that could increase the risk of rejection. Pregnancy following LDLT carries the additional risk of hemodynamic changes associated with smaller than normal total lung volumes. The aim of this study was to evaluate outcomes following pregnancy with LDLT. MethodsA retrospective review was conducted to identify all patients who received LDLT and subsequently became pregnant. Institutions which previously published on LDLT were contacted to identify all LDLT patients that had become pregnant. This included our own institutional results as well as those of Massachusetts’s General Hospital, St. Louis Children’s Hospital, the National Transplantation Pregnancy Registry and the experiences from Okayama, Japan and Middlesex County, UK. A retrospective review was conducted to identify all patients who received LDLT and subsequently became pregnant. Institutions which previously published on LDLT were contacted to identify all LDLT patients that had become pregnant. This included our own institutional results as well as those of Massachusetts’s General Hospital, St. Louis Children’s Hospital, the National Transplantation Pregnancy Registry and the experiences from Okayama, Japan and Middlesex County, UK. ResultsA total of four LDLT patients and five pregnancies were identified, all from our institution. The median age at transplant was 24 years (range 21-29). The indication for transplant in all patients was cystic fibrosis and each received bilateral LDLTs on cardiopulmonary bypass. Median left lung ischemic time was 43 min, median right lung ischemic time was 62 min and median pump time was 150 min. Median time to pregnancy was 6 years post transplant (range 1-6 years). Median gestation time was 36 weeks (range 34 to 37 weeks). Two patients suffered pre-ecclampsia, but no patient developed pulmonary hypertension or acute rejection during pregnancy. Median time from transplant to telephone interview was 17 years. No patient has developed worsening pulmonary function or acute/chronic rejection. One patient developed lymphoma which is in remission. All 5 children of these LDLT patients are well and none has cystic fibrosis. A total of four LDLT patients and five pregnancies were identified, all from our institution. The median age at transplant was 24 years (range 21-29). The indication for transplant in all patients was cystic fibrosis and each received bilateral LDLTs on cardiopulmonary bypass. Median left lung ischemic time was 43 min, median right lung ischemic time was 62 min and median pump time was 150 min. Median time to pregnancy was 6 years post transplant (range 1-6 years). Median gestation time was 36 weeks (range 34 to 37 weeks). Two patients suffered pre-ecclampsia, but no patient developed pulmonary hypertension or acute rejection during pregnancy. Median time from transplant to telephone interview was 17 years. No patient has developed worsening pulmonary function or acute/chronic rejection. One patient developed lymphoma which is in remission. All 5 children of these LDLT patients are well and none has cystic fibrosis. ConclusionPregnancy after LDLT is a rare event, but appears to be safe and has good outcomes in well managed patients. The complications of pulmonary hypertension and rejection may be overestimated in this population. Pregnancy after LDLT is a rare event, but appears to be safe and has good outcomes in well managed patients. The complications of pulmonary hypertension and rejection may be overestimated in this population.