Pregnancy Management and Outcomes in a Small Bowel, Pancreas, and Liver Transplant Recipient: A Case Report and Literature Review.
Recommended Citation
Abusuliman M, Olimy A, Aboeldahb M, Abusuliman A, Dawod S, Rehman S, Salem AE, Meribout S, Aloum K, and Jafri SM. Pregnancy Management and Outcomes in a Small Bowel, Pancreas, and Liver Transplant Recipient: A Case Report and Literature Review. Am J Case Rep 2024; 25:e945914.
Document Type
Article
Publication Date
11-15-2024
Publication Title
Am J Case Rep
Abstract
BACKGROUND: Small bowel transplantation (SBT) is a rare but life-saving surgery. However, successful full-term pregnancies in individuals with SBT are exceedingly rare due to the nutritional and immunosuppression challenges this transplant poses for pregnancy. Therefore, clear guidelines for treating pregnant SBT recipients are unavailable. Here, we report the second case of a successful pregnancy in an individual with a triple organ transplant, including SBT, highlighting the need for careful immunosuppressive management and multidisciplinary care.
CASE REPORT: A 20-year-old woman in the third trimester of pregnancy with a history of small bowel, liver, and pancreas transplantation at age 1 year presented with elevated liver function test results. She had been taking tacrolimus, sirolimus, and prednisone before pregnancy, with no signs of organ rejection. While sirolimus and prednisone was discontinued upon conception, laboratory test results at presentation revealed low serum tacrolimus levels. The patient had an acute kidney injury and pulmonary edema during her hospitalization and received a diagnosis of preeclampsia. She underwent a successful cesarean delivery, due to labor induction complications; however, about 1 month after hospital discharge, the patient experienced elevated liver enzymes, which was treated with high-dose steroids and adjusted tacrolimus. Sirolimus was restarted, and the patient's liver enzymes have been normalized to date.
CONCLUSIONS: Comprehensive multidisciplinary care, as well as monitoring and optimizing immunosuppression, are essential for pregnant SBT recipients throughout the prenatal, perinatal, and postpartum periods to mitigate risks, prevent graft rejection, and ensure positive maternal and fetal health outcomes.
Medical Subject Headings
Humans; Female; Pregnancy; Liver Transplantation; Intestine, Small; Pancreas Transplantation; Young Adult; Immunosuppressive Agents; Pregnancy Complications; Pregnancy Outcome; Tacrolimus
PubMed ID
39543857
Volume
25
First Page
945914
Last Page
945914
