Pregnancy after liver transplant: maternal and perinatal outcomes.

BACKGROUND: Liver transplantation is a life-saving and successful therapeutic procedure which is more and more frequent worldwide, also among women of reproductive age. Consequently, there is an increasing number of reports of pregnancy following liver transplantation, but doubts still exist regarding preconception counseling and the optimal method of managing pregnancy. The aim of this study was to report and evaluate pregnancy outcomes in women who had undergone liver transplantation. METHODS: We retrospectively analyzed female patients after orthotopic liver transplantation who reported pregnancy and were under medical care of a single transplant center. RESULTS: We identified 14 pregnancies in 10 women who had undergone liver transplantation (12 childbirths, one induced abortion due to fetal death in the first trimester, one pregnancy is still ongoing). Causes of transplantation include congenital or acquired disorders and the most common indication was autoimmune hepatitis (50%). The mean age at the point of transplantation was 28.5 (range 21-36), mean maternal age at pregnancy was 32 (range 26-43), and transplant-to-pregnancy interval was 4.07 years (range 1.5-7). The mean gestational week was 36.67 (range 31-40). Immunosuppression was maintained with combinations of prednisone (n = 11), tacrolimus (n = 13), and azathioprine (n = 8) prior to and during pregnancy. Two pregnancies were unintended, so women took mycophenolate mofetil in the first weeks of gestation. Another two women stopped taking azathioprine due to increasing anemia. Maternal complications included increase of aspartate transaminase and alanine transaminase (n = 2), anemia (n = 4) and hyperthyroidism (n = 2). Among the 12 childbirths, five (41.67%) were preterm. Only five women entered labor spontaneously, while seven (58,33%) had cesarean delivery. CONCLUSIONS: Pregnancy after liver transplantation can achieve relatively favorable outcomes. Liver transplantation does not influence women's fertility and, during pregnancy, we report low rates of minor graft complications. A multidisciplinary team should be involved in contraceptive, fertility and consequently pregnancy counseling of female transplant recipients.

Learning Climate Perceptions as a Determinant of Employability: An Empirical Study Among European ICT Professionals.

This study investigated the role of age in the relationship between perceptions of learning climate and self- and supervisor-rated employability among European Information and Communication Technology (ICT) professionals. The psychological climate for learning was operationalized by three indicators, namely the perceptions that employees have of the learning value of their job, supervisor support for learning, and the organizational support for learning. As hypothesized, a Structural Equation Model demonstrated that the relationship between age and perceptions of learning climate was negative. The model also showed a strong positive relationship between learning climate and self-reported and supervisor-rated employability. Furthermore, learning climate perceptions appeared important for employability irrespective of life or career stage. An explorative bootstrapping-based test suggested that older workers with managerial responsibilities profit less from psychological learning climate for self-reported and supervisor-rated employability than older workers at non-managerial levels. These findings have important implications for human resource practices that aim to increase lifelong employability.

Supervisor-subordinate age dissimilarity and performance ratings: the buffering effects of supervisory relationship and practice.

Using 394 pairs of employees and their immediate supervisors working in the Information and Communication Technology (ICT) sector in three northern European countries, this study examined the effect of workplace moderators on the link between relational demography and supervisor ratings of performance. Directional age differences between superior and subordinate (i.e., status incongruence caused when the supervisor is older or younger than his/her subordinate) and non-directional age differences were used as predictors of supervisor ratings of occupational expertise. The quality of the supervisor-subordinate relationship and the existence of positive age-related supervisory practices were examined as moderators of this relationship. The results provide no support for a relationship between directional age differences and age-related stereotyping by supervisors in ratings of performance, neither for the effects of age-related supervisory practices. However, high quality supervisor-subordinate relationships did moderate the effects of age dissimilarity on supervisory ratings. The implications of these findings for performance appraisal methodologies and recommendations for further research are discussed.