Pregnancy Outcomes in Pediatric Heart Transplant Recipients. Abstract# B1246

Introduction: Pediatric heart transplant (HT) recipients are surviving to become adults. We present a descriptive study of 10 pregnancies occurring from 2006 through 2013 in patients who received a HT in infancy or childhood. Methods: The database of 500 pediatric HT recipients at our institution was reviewed and all known pregnancies over the last 8 years were identified. 104 female patients have reached child bearing age. Data reviewed for each patient included age at transplant, pre-transplant diagnosis, pre-pregnancy medications, angiograms and donor specific antibodies when available, pregnancy medications and complications, delivery complications, fetal outcomes and post-pregnancy angiograms and donor specific antibodies. Results: 10 pregnancies were identified from a total of 7 HT recipients. Three women had 2 pregnancies each. 8 infants were delivered, including one set of twins. Maternal age ranged from 19 - 27 years. Time from HT ranged from 3 to 26 years. All non-essential potentially teratogenic medications were discontinued on the first visit with high risk obstetric management throughout pregnancy. Patients were followed by transplant at least monthly throughout pregnancy for medication adjustment and serial echocardiograms. The most common medication regimen included a calcineurin inhibitor and sirolimus +/- prednisone. No patient was diagnosed with rejection while pregnant. Three pregnancies were electively terminated in the first trimester. No maternal or fetal deaths occurred. Conclusion: Successful pregnancy and delivery is possible in the pediatric heart transplant population. Significant risks exist, including preterm labor, fetal malformation, and maternal complications, including the development of donor specific antibodies and worsening of CAV. (Table Presented).