Introduction

The numbers of women of child-bearing age undergoing heart transplantation (HT) and female pediatric HT recipients surviving to child-bearing age have increased, along with improvements in post-transplant survival. Data regarding life expectancy and comorbidities in reproductive-aged female HT recipients are needed to inform shared decision-making at the time of preconception counseling.

Methods

The International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant Registry was investigated for HT recipients between January 1, 2000 and June 30, 2017. Women of childbearing age were defined as those aged 15-45 years, either at transplant, or at the respective post-transplant follow-up. Characteristics and outcomes of female recipients of childbearing age at transplant, 5-, 10-, and 15-year follow-up were compared to females > 45 years of age, males 15-45 years and males > 45 years of age at the corresponding time intervals. Outcomes included survival, development of diabetes (DM), severe renal dysfunction (CKD), and cardiac allograft vasculopathy (CAV).

Results

During the study period, 71585 HT recipients were included: 24% (n= 17194) were female and 9.2% (n=6602) were of childbearing age at HT. A pre-transplant diagnosis of peripartum cardiomyopathy was associated with significantly worse post-transplant survival, a finding that remained independent of panel reactive antibody levels. The presence of pre-transplant DM and/or severe CKD was significantly associated with lower survival as were the presence of CAV, DM, and CKD post-HT.

Discussion

Knowledge of the impact on survival of pre-existing comorbidities and complications post-HT are important for risk stratification for preconception counseling post-HT.

中文翻译：

---

告知孕前咨询：ISHLT 登记处女性心脏移植受者的结果

 介绍

接受心脏移植 (HT) 的育龄妇女和存活到育龄的女性儿科 HT 接受者数量有所增加，移植后存活率也有所提高。需要有关育龄女性 HT 接受者的预期寿命和合并症的数据，以便在孕前咨询时为共同决策提供信息。

 方法

国际心肺移植协会 (ISHLT) 胸腔器官移植登记处对 2000 年 1 月 1 日至 2017 年 6 月 30 日期间的 HT 接受者进行了调查。育龄妇女的定义是年龄在 15 岁至 45 岁之间，无论是在移植时，还是在在相应的移植后随访中。将移植时育龄女性受者、5 年、10 年和 15 年随访时的特征和结果与相应年龄 > 45 岁的女性、15-45 岁的男性和 > 45 岁的男性进行比较时间间隔。结果包括生存、糖尿病（DM）、严重肾功能障碍（CKD）和心脏同种异体移植血管病变（CAV）的发展。

 结果

研究期间，纳入了 71585 名 HT 接受者：24%（n=17194）为女性，9.2%（n=6602）为 HT 育龄人群。移植前诊断出的围产期心肌病与移植后存活率显着下降相关，这一发现与反应性抗体水平无关。移植前 DM 和/或严重 CKD 的存在与 HT 后 CAV、DM 和 CKD 的存在一样，与较低的存活率显着相关。

 讨论

了解 HT 后现有合并症和并发症对生存的影响对于 HT 后孕前咨询的风险分层非常重要。