Successful term pregnancy in an intestine-pancreas transplant recipient with chronic graft dysfunction and parenteral nutrition dependence: a case report.
Pregnancy after solid organ transplantation is becoming more common, with the largest recorded numbers in renal and liver transplant recipients. Intestinal transplantation is relatively new compared to other solid organs, and reports of successful pregnancy are far less frequent. All pregnancies reported to date in intestinal transplant recipients have been in women with stable graft function. The case reported here involves the first reported successful term pregnancy in an intestine-pancreas transplant recipient with chronic graft dysfunction and dependence on both transplant immunosuppression and parenteral nutrition (PN) at the time of conception. Pregnancy was unplanned and unexpected in the setting of chronic illness and menstrual irregularities, discovered incidentally on abdominal ultrasound at approximately 18 weeks' gestation. Rapamune was held, tacrolimus continued, and PN adjusted to maintain consistent weight gain. A healthy female infant was delivered vaginally at term. Medical complications during pregnancy included anemia and need for tunneled catheter replacements. Ascites and edema were improved from baseline, with recurrence of large volume ascites shortly after delivery. Successful pregnancy is possible in the setting of transplant immunosuppression, chronic intestinal graft dysfunction, and long-term PN requirement, but close monitoring is required to ensure the health of mother and child.
Department of Pediatrics, DGSOM at UCLA, Los Angeles, California, United States; VA Greater Los Angeles Health Care System, Los Angeles, California, United States. Electronic address: emarcus@mednet.ucla.edu.
E A
EA
Marcus
Department of Pediatrics, DGSOM at UCLA, Los Angeles, California, United States.
L J
LJ
Wozniak
Department of Pediatrics, DGSOM at UCLA, Los Angeles, California, United States; Dumont-UCLA Transplant Center, Department of Surgery, DGSOM at UCLA, Los Angeles, California, United States.
R S
RS
Venick
Dumont-UCLA Transplant Center, Department of Surgery, DGSOM at UCLA, Los Angeles, California, United States.
S M
SM
Ponthieux
Dumont-UCLA Transplant Center, Department of Surgery, DGSOM at UCLA, Los Angeles, California, United States.
E Y
EY
Cheng
Dumont-UCLA Transplant Center, Department of Surgery, DGSOM at UCLA, Los Angeles, California, United States.
D G
DG
Farmer
D000328:Adult; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D016035:Pancreas Transplantation / Q000379:methods*; D010288:Parenteral Nutrition; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D055031:Primary Graft Dysfunction; D020123:Sirolimus / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D066027:Transplant Recipients
D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus