Perinatal Outcomes after Liver Transplantation: Is There a Role for Aspirin Treatment?

Background: We aimed to describe perinatal outcomes and evaluate aspirin treatment effects in liver-transplanted pregnant women. Methods: A retrospective study examining perinatal outcomes in liver transplant recipients at a single center (2016–2022). The effect of low-dose aspirin treatment on the risk of developing hypertensive disease in these patients was evaluated. Results: Fourteen deliveries in 11 pregnant liver transplant recipients were identified. Primary liver disease was Wilson’s in 50% of pregnancies. The median age was 23 years at transplant and 30 at conception. Tacrolimus was administered in all, steroids in 10 (71.43%), and aspirin (100 mg daily) in 7 (50.0%). Overall, two women (14.28%) developed preeclampsia, and one (7.14%) developed gestational hypertension. Median gestational age at delivery was 37 weeks (31–39 weeks), with six preterm births (between 31–36 weeks) and a median birthweight of 3004 g(range 1450–4100 g). None of those receiving aspirin developed hypertensive disease or suffered excessive bleeding during pregnancy, compared to two (28.57%) with pre-eclampsia in the non-aspirin group. Conclusion: Liver-transplanted pregnant women comprise a unique and complex patient population with overall favorable pregnancy outcomes. Based on our single-center experience and due to its safety profile and potential benefit, we recommend low-dose aspirin in all liver transplanted patients during pregnancy for preeclampsia prevention. Further large prospective studies are needed to corroborate our findings.