Successful Term Pregnancy in an Intestine-Pancreas Transplant Recipient With Chronic Graft Dysfunction and Parenteral Nutrition Dependence: A Case Report

Abstract

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.

Multidisciplinary care ensures successful pregnancy following intestinal transplantation: a case report

“…This case adds to the body of evidence supporting the possibility of successful pregnancy following intestinal transplantation and demonstrates caesarean section is a safe route of delivery post‐transplant despite complex abdominal reconstruction. The first reported successful pregnancy in a patient following intestinal transplant was in 2006 with three further successful pregnancies reported in this patient group . Due to the non‐vascularised fascia, at an MDT planning meeting in the antenatal phase of our patient, the MDT were concerned she would have insufficient muscle strength to allow a normal vaginal delivery and would risk herniation of her abdominal contents.…”

13. Pregnancy after liver and other transplantation

“…Intestinal transplantation has shown steady improvements in graft and patient survival over the past 20 years and is rapidly becoming more established worldwide [35]. The first pregnancy after intestinal transplant was described in 2006 [36], followed later by few other reports [37][38][39][40] with 100% success rate. Specific to this procedure, there are two factors affecting the transplant to be considered in case of pregnancy: higher need of immunosuppressants and absorptive function of transplanted bowel.…”