Pregnancy outcomes after living liver donation: A multi-institutional study.

BACKGROUND Nearly half of living liver donors in North America are women of child-bearing age. Fetal and maternal outcomes after donation are unknown. METHODS We conducted a retrospective cohort study of female living liver donors (age 18-50 at donation) from six transplant centers. Participants were surveyed about their pregnancies and fertility. Outcomes were compared between pre-donation and post-donation pregnancies. Generalized estimating equations clustered on donor and adjusted for age at pregnancy, parity, and pregnancy year. RESULTS Among 276 donors surveyed, 151 donors responded (55% response rate) and reported 313 pregnancies; 168/199 (68.8%) of the pre-donation pregnancies and 82/114 (71.9%) of the post-donation pregnancies resulted in live births while 16.6% and 24.6% resulted in miscarriage, respectively. Women with post-donation pregnancies were older (32.0 vs. 26.7 years, p<0.001), and more frequently reported abnormal liver enzymes during pregnancy (3.5% vs 0.0%, p=0.017) and delivery via cesarean-section (35.4% vs. 19.7%, p=0.01). On adjusted analysis, there was no difference in cesarean-section (OR: 2.44 [0.98-6.08]), miscarriage (OR 1.59 [0.78-3.24]), or combined end-points of pregnancy-induced hypertension and pre-eclampsia (OR: 1.27 [0.36-4.49]), or intrauterine growth restriction and preterm birth (OR: 0.91 [0.19-4.3]). Of the 49 women who attempted pregnancy after donation, 11 (22.5%) self-reported infertility; however, 8/11 (72.7%) eventually had live births. CONCLUSIONS Aside from increased reporting of abnormal liver enzymes and cesarean-sections, there was no significant difference in pregnancy outcomes before and after living liver donation. One-fifth of women who attempt pregnancy after liver donation reported infertility and while the majority went on to a successful live birth, further exploration is needed to understand contributing factors. Future research should continue to monitor this patient-centered outcome across a large cohort of donors.