Case series

We present a case series of eight female lung transplant recipients who used combined hormonal contraception (CHC). Pregnancies after lung transplantation are rare1 but can put the woman and the fetus at high risk. It has been reported that pre-eclampsia develops in approximately 25% of lung recipients, often leading to preterm delivery and low birth weight.2 Little is known about the influence of pregnancy per se on the risk of transplant rejection, although the rejection rate seems similar to that in the non-pregnant population.2 However, the National Transplantation Pregnancy Registry (NTPR) reported that 27% of woman in the lung transplant pregnancy cohort experienced a rejection episode, with 21% experiencing graft loss within 2 years after pregnancy. Thus, this group of women is considered high risk when compared with other solid organ recipients and are often advised against pregnancy.

Although it is recommended that women use a safe and reliable method of contraception, the safety of hormonal contraception in female lung transplant recipients might be problematic. Despite the fact that the effect of estrogens on the pulmonary vascular system remains poorly understood, higher estrogen levels in women may predispose them to having a more vulnerable pulmonary circulation, which could more easily foster the development of pulmonary arterial hypertension.3 Hence, the aim of this study was to evaluate the safety of CHC in women after lung transplantation.