Successful pregnancy following orthotopic liver transplantation for idiopathic Budd-Chiari syndrome.
Budd-Chiari syndrome is a rare and serious thrombotic event with significant morbidity and mortality. Recommendations regarding future conception and management during pregnancy have not been defined. We present a patient with history of idiopathic Budd-Chiari Syndrome and subsequent orthotopic liver transplantation who was successfully managed during pregnancy. A 24-year-old white female, gravida 1 para 0, status postorthotopic liver transplantation 5 years previously for Budd-Chiari syndrome with post-transplant insulin-dependent diabetes mellitus presented to our clinic at 7 weeks of gestation for initial prenatal evaluation. Maintenance immunosuppressive therapy and prophylactic heparin anticoagulation was administered throughout the pregnancy, which was uneventful until 35 weeks gestation, at which time pre-eclampsia and premature preterm rupture of membranes prompted labor induction. The patient developed no evidence of acute or chronic hepatic rejection and no evidence of recurrent Budd-Chiari syndrome during the pregnancy or post-partum convalescence. Prudent use of prophylactic anticoagulation, close immunosuppressive monitoring, and periodic fetal and maternal surveillance are warranted in patients with previous orthotopic liver transplantation for idiopathic Budd-Chiari syndrome and may reduce risk of recurrence during pregnancy.
Department of Obstetrics/Gynecology, Mayo Medical Center, Rochester, Minnesota 55905, USA.
P S
PS
Ramsey
J E
JE
Hay
K D
KD
Ramin
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007751:Labor, Induced; D016031:Liver Transplantation; D011225:Pre-Eclampsia; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics
D007166:Immunosuppressive Agents; D006493:Heparin