PubMedAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons2026-07-25
Contraception Use Differs Across Solid Organ Transplant Types Among Women Transplanted in Reproductive Age.
Cooper Katherine M KM, Mahle Rachael E RE, Joyal Kayla K, Le Mariesa M et al.
There are a growing number of reproductive age solid organ transplant (SOT) recipients, yet comparative data on contraception use across organ types are limited. We performed a retrospective cohort study of women who underwent first-time liver, kidney, heart, or lung transplantation between the ages of 18 and 45 from 2015 and 2025 using TriNetX (n=10,155). Contraception uptake within two years was assessed by organ, including patterns of initial contraceptive choice and subsequent changes in contraception choice, and clinical outcomes, including osteoporosis, thromboembolism, and graft rejection, were compared by contraception type. Among 10,155 eligible SOTR, 19.9% had documented contraception within two years of SOT (heart 27.3%, lung 22.5%, kidney 19.7%, liver 16.8%, p<0.001). Combined oral contraception was the most common initial contraception method, followed by depot medroxyprogesterone acetate (DMPA). However, those who started on DMPA were more likely to switch medications. Compared with no contraception, DMPA was associated with increased osteoporosis, hypertension, thrombosis, and graft rejection, whereas estradiol-containing agents were not. Overall, contraception use after SOT was extremely uncommon with exceedingly low rates of highly effective options, particularly after liver and kidney transplant. Higher switching and adverse associations with DMPA support early, organ-tailored contraceptive counseling and careful method selection post-SOT.