Pregnancy in a post-cardiac transplant patient

    Authors

    Keywords

    heart transplant, pregnancy, immunosuppression

    DOI

    https://doi.org/10.15836/ccar2021.20

    Full Text

    Background : The number of transplant patients of childbearing age has increased. Decisions regarding the pregnancy management are challenging. Close monitoring includes screening for complications including rejection, graft dysfunction, and infection. First pregnancy in a post-cardiac transplant patient was reported in 1988 in a female patient who conceived less than 2 years post-transplant. Since then, there are many case reports that have demonstrated successful pregnancies in solid organ transplant recipients. ( 1 - 3 ) Case report : We present a case of 42-years-old female patient who underwent heart transplant 2016. In 2018 the patient expressed wishes for pregnancy and childbirth. A multidisciplinary team of cardiologists and gynecologists was formed and preconception and genetic counseling given. Before pregnancy we adjusted standard immunosuppressant therapy – mycophenolate mofetil was excluded, prednisone was continued in dose of 5 mg daily, and tacrolimus titrated to achieve concentration of 10-15 ng/ml. One month later, myocardial biopsy excluded graft rejection and 6 months later patient conceived naturally. Graft function was assessed by regular monthly NT-proBNP check. Echocardiography performed at 4 th and 35 th week of pregnancy showed normal graft function. In 36th week of pregnancy patient was admitted to our Department due to renal failure and hyperkalemia and was treated conservatively. Due to labor contractions on the 7th day of hospitalization, urgent caesarean section was performed in general anesthesia. Our patient gave birth to a healthy male newborn, without post-partal complications. Standard immunosuppressant therapy with mycophenolate mofetil, tacrolimus and prednisone was introduced immediately after birth. Repeated myocardial biopsy performed in the follow-up showed no signs of graft rejection. Conclusion : Pregnancy and childbirth in post-cardiac transplant patient is feasible and should be managed by multidisciplinary team of healthcare providers.

    Cardiologia Croatica
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    Pregnancy in a post-cardiac transplant patient

    Extended Abstract
    Issue1-2
    Published
    Pages20
    PDF via DOIhttps://doi.org/10.15836/ccar2021.20
    heart transplant
    pregnancy
    immunosuppression

    Authors

    Mia Dubravčić*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Maja ČikešORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Daniel LovrićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jure SamardžićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jana Ljubas MačekORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Ivo PlanincORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Marijan PašalićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Nina JakušORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Dora FabijanovićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Davor MiličićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Boško SkorićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    Full Text

    Background : The number of transplant patients of childbearing age has increased. Decisions regarding the pregnancy management are challenging. Close monitoring includes screening for complications including rejection, graft dysfunction, and infection. First pregnancy in a post-cardiac transplant patient was reported in 1988 in a female patient who conceived less than 2 years post-transplant. Since then, there are many case reports that have demonstrated successful pregnancies in solid organ transplant recipients. ( 1 - 3 ) Case report : We present a case of 42-years-old female patient who underwent heart transplant 2016. In 2018 the patient expressed wishes for pregnancy and childbirth. A multidisciplinary team of cardiologists and gynecologists was formed and preconception and genetic counseling given. Before pregnancy we adjusted standard immunosuppressant therapy – mycophenolate mofetil was excluded, prednisone was continued in dose of 5 mg daily, and tacrolimus titrated to achieve concentration of 10-15 ng/ml. One month later, myocardial biopsy excluded graft rejection and 6 months later patient conceived naturally. Graft function was assessed by regular monthly NT-proBNP check. Echocardiography performed at 4 th and 35 th week of pregnancy showed normal graft function. In 36th week of pregnancy patient was admitted to our Department due to renal failure and hyperkalemia and was treated conservatively. Due to labor contractions on the 7th day of hospitalization, urgent caesarean section was performed in general anesthesia. Our patient gave birth to a healthy male newborn, without post-partal complications. Standard immunosuppressant therapy with mycophenolate mofetil, tacrolimus and prednisone was introduced immediately after birth. Repeated myocardial biopsy performed in the follow-up showed no signs of graft rejection. Conclusion : Pregnancy and childbirth in post-cardiac transplant patient is feasible and should be managed by multidisciplinary team of healthcare providers.