Our Summary

Pulmonary hypertension (PH) is a condition where the pressure in the blood vessels of the lungs is abnormally high. This condition can be dangerous, especially for pregnant women, and often doctors advise against pregnancy for women with PH because of the risks involved.

However, there are increasing reports of pregnancies in women with PH, half of which were unplanned. Surprisingly, two-thirds of these pregnancies have resulted in healthy babies, despite the higher risks of premature birth, low birth weight, and other complications.

When these pregnancies are managed by a team of experts in specialized centers, the chances of a successful outcome increase. Additionally, lung transplants, often the last resort treatment for PH, can restore a woman’s fertility. However, pregnancies after a lung transplant come with a higher risk of rejection of the transplanted lung and increased mortality compared to other organ transplant recipients.

Therefore, it’s crucial for women with PH to have a thorough medical assessment before deciding to become pregnant to optimize their health and the health of their future baby.

FAQs

  1. What is Pulmonary Hypertension (PH) and how is it categorized?
  2. What are the risks associated with pregnancy after a lung transplant?
  3. How does a lung transplant affect fertility and pregnancy outcomes in women with Pulmonary Hypertension?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung transplant is to ensure they have a thorough preconception assessment before attempting pregnancy. This assessment is vital in optimizing maternal and pregnancy outcomes, especially for patients with pulmonary hypertension and other progressive lung diseases. It is important to be monitored closely by a multidisciplinary team in specialized centers to manage any potential complications that may arise during pregnancy. Additionally, patients should be aware of the increased risk of graft rejection and mortality associated with pregnancy after lung transplant compared to recipients of other organs.

Suitable For

Patients who are typically recommended for lung transplant include those with severe and progressive lung diseases such as pulmonary hypertension, cystic fibrosis, chronic obstructive pulmonary disease (COPD), and idiopathic pulmonary fibrosis. These patients may have exhausted all other treatment options and have a significantly decreased quality of life due to their lung disease. Lung transplant may be considered as a last resort to improve their symptoms and overall health.

It is important for patients to undergo a thorough evaluation by a multidisciplinary team to determine if they are suitable candidates for lung transplant. This evaluation will assess their overall health, lung function, and ability to tolerate the surgery and post-transplant medications. Patients who are deemed to have a good prognosis following lung transplant may be recommended for the procedure.

It is important to note that lung transplant is a major surgery with potential risks and complications, and patients must be willing to commit to lifelong medical management and follow-up care. Additionally, patients must be emotionally and mentally prepared for the challenges that come with undergoing a lung transplant.

Timeline

  • Before lung transplant:
  1. Patient is diagnosed with a progressive lung disease such as pulmonary hypertension.
  2. Patient undergoes evaluation and testing to determine if they are a suitable candidate for lung transplant.
  3. Patient is placed on a waiting list for a donor lung.
  4. Patient may experience worsening symptoms and decreased quality of life while waiting for a transplant.
  • After lung transplant:
  1. Patient undergoes surgery to receive a new lung from a donor.
  2. Patient is closely monitored in the hospital for complications and to ensure proper healing.
  3. Patient begins a long-term regimen of immunosuppressant medications to prevent rejection of the transplant.
  4. Patient participates in pulmonary rehabilitation to regain strength and improve lung function.
  5. Patient continues to be monitored regularly by a medical team to assess the function of the transplant and monitor for any complications.
  6. Patient may experience an improvement in symptoms and quality of life, but must adhere to strict medication and lifestyle guidelines to maintain the health of the new lung.

What to Ask Your Doctor

  1. What is my current lung function and overall health status, and how does this affect my eligibility for a lung transplant?

  2. What are the potential risks and benefits of a lung transplant for me, given my specific health condition?

  3. How long is the waiting period for a suitable donor lung, and what are the factors that can affect this waiting time?

  4. What is the success rate of lung transplants in patients with my specific condition, and what are the potential complications or side effects I should be aware of?

  5. How will I need to prepare for a lung transplant, both physically and emotionally, and what kind of post-transplant care will be required?

  6. What are the long-term outcomes and expectations for life after a lung transplant, including the possibility of rejection or other complications?

  7. How will a lung transplant affect my ability to have children or get pregnant in the future, and what precautions should I take if I do decide to become pregnant?

  8. What kind of support or resources are available for patients undergoing a lung transplant, both during the transplant process and afterwards?

  9. Are there any specific lifestyle changes or medications that I will need to adhere to after a lung transplant, to ensure the best possible outcome for my health and well-being?

  10. What is the likelihood of needing a second lung transplant in the future, and what factors may contribute to this need?

Reference

Authors: Lao TT. Journal: Best Pract Res Clin Obstet Gynaecol. 2022 Dec;85(Pt A):70-82. doi: 10.1016/j.bpobgyn.2022.06.002. Epub 2022 Jun 26. PMID: 35868979