Pregnancy in a patient with hepatic artery thrombosis after liver transplantation: a case report.
BACKGROUND
Hepatic artery thrombosis (HAT) increases the risk of complications and mortality after liver transplantation. The incidence for HAT is increased in patients with risk factors (vascular reconstructions, coagulation disorders and acute rejection episodes amongst others). Early retransplantation improves the prognosis for patients, but owing to lack of donors, surgical and interventional radiologic attempts to restore the patency of hepatic artery are made. The prognosis for the liver and the patient can also be improved by the development of collateral circulation.


METHODS
We describe a case of a 30-year-old woman with hepatic failure owing to Wilson disease. Liver transplantation with the use of vascular conduit made of donor's iliac arteries was complicated by an early HAT. Heterozygous factor V Leiden mutation was confirmed in the patient. Despite surgical and radiologic attempts to restore patency and despite treatment with fractioned heparin and aspirin, the hepatic artery remained occluded. Retransplantation was not considered, even though the patient was planning a pregnancy. After 1 year of observation of stable liver function, conversion from mycophenolate mofetil to azathioprine treatment, the patient was given consent for a high-risk pregnancy.


CONCLUSIONS
The course of pregnancy was uneventful, with normal liver function parameters, without pathological bleedings. The patient was treated with doses of enoxaparin adjusted for the patient's weight. In the 34th week, owing to increasing concentration of bile acids, the pregnancy ended with a cesarean section. The newborn had 10-point APGAR score.
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warszawa, Poland. Electronic address: olgatronina@wp.pl.
O
O
Tronina
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warszawa, Poland.
N
N
Mikołajczyk
First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warszawa, Poland.
B
B
Pietrzak
Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warszawa, Poland.
M
M
Pacholczyk
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warszawa, Poland.
M
M
Durlik
D020016:Activated Protein C Resistance / Q000188:drug therapy; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D003097:Collateral Circulation; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006527:Hepatolenticular Degeneration / Q000150:complications; D006801:Humans; D007668:Kidney / Q000098:blood supply; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology* / Q000628:therapy
D000925:Anticoagulants; D017984:Enoxaparin