Health Outcomes of Children Born to Liver Transplant Recipients

Leveraging the Transplant Pregnancy Registry International, we conducted a retrospective study of children born to liver transplant (LT) recipients between 1986-2023 to evaluate long term health outcomes of offspring. Child data were collected primarily from bi-yearly maternal phone interviews. Descriptive statistics and multivariate analyses were used to evaluate risk factors for adverse child outcomes. There were 599 children with follow-up data, born to 435 LT recipients of whom 73% were white and 13.1% Hispanic with a median age at conception of 29.4 yrs. The most common LT indications were autoimmune hepatitis (14.2%) and biliary atresia (13.9%); Time from LT to delivery was median 6.9 yrs (IQR 3.1, 14.2); 21.0.% of mothers required anti-hypertensives in pregnancy, 20.7% developed preeclampsia, and 46.1% had cesarean delivery. Most (68.3%) children were healthy and developing well at median 7.6 (IQR: 3.3, 14.9) years of follow up. The most common pediatric conditions in offspring were allergies (6.5%), asthma/reactive airway disease (4.7%), attention deficit hyperactivity disorder/ attention deficit disorder (ADHD/ADD) (2.3%), mild developmental delay (2.7%), autism spectrum disorder (2.0%), and mood disorders (1.2%). Most school-age children of LT recipients were healthy overall, without greater risk for growth or cognitive conditions than the general pediatric population.