Perinatal Outcomes After Liver Transplantation – Is There A Role For Aspirin Treatment?

Abstract Purpose: To describe perinatal outcomes in liver transplanted women and evaluate the effect of low-dose aspirin treatment in these women.Methods: An observational retrospective study examining perinatal outcomes among 10 liver transplant recipients, between 2016-2020 at a single university-affiliated tertiary medical center in Israel. Demographic, obstetric and clinical data were obtained from electronic health records. Low-dose aspirin use in these women during pregnancy began in 2018 and was evaluated with regards to its effect on the risk of developing preeclampsia and hypertensive disease. Results: Overall, 13 deliveries in 10 pregnant liver transplant recipients were identified. Primary liver disease was Wilson's in 7 pregnancies (53%), acute liver failure in 3 (23%), and a single woman with each of the following: Viral hepatitis A, Hyperoxaluria type 1 and primary sclerosing cholangitis. Median age was 23 years at transplant and 30 at conception. All recipients received tacrolimus, steroids were administered to 9 (69%), and low-dose aspirin (100mg daily) administered in 5 (38%) pregnancies. Regarding maternal outcomes, 2 women (16%) developed preeclampsia, 1 (8%) developed gestational hypertension, and 3 (24%) had postpartum infection. Of women receiving low-dose aspirin, none developed hypertensive disease or suffered excessive bleeding. Median gestational age at delivery was 37 weeks (31–39 weeks), with 6 preterm births (31-36) and a median birthweight of 3072g (1450–4100g). Conclusions: Liver-transplanted pregnant women comprise a unique and complex patient population. Based on our single-center experience and due to its potential benefit, low-dose aspirin may by a possible preventive measure for preeclampsia. Further prospective, large studies are needed to delineate specific complications in this patient population and to evaluate treatment options, in order to improve maternal and neonatal outcomes.