First successful perinatal management of pregnancy after ABO-incompatible liver transplantation

World J Gastroenterol. 2017 Jan 21;23(3):547-550. doi: 10.3748/wjg.v23.i3.547.

Abstract

Many papers have reported on pregnancy and delivery after liver transplantation, but there have been no reports on pregnancy after ABO-incompatible liver transplantation. This paper reports the first successful pregnancy and delivery of a newborn after ABO-incompatible liver transplantation for fulminant hepatic failure. The patient was a 39-year-old female. She had an ABO-incompatible liver transplantation, donated from her husband, due to subacute fulminant hepatitis of unknown etiology. She was taking tacrolimus, methylprednisolone, and mizoribine orally for the maintenance of immunosuppression at the time of discharge. She was discharged uneventfully on postoperative day 38 without any rejection episodes. At 1 year and 6 mo after transplantation, she indicated a wish to become pregnant. Therefore, treatment with mycophenolate mofetil was interrupted at that time. After two miscarriages, she finally became pregnant and delivered transvaginally 3 years after the transplantation. All of the pregnancies were conceived naturally. The newborn was female with a birth weight of 3146 g; the Apgar scores were 9 and 10. Delivery was performed smoothly, and the newborn exhibited no malformations. The mother and the newborn were discharged uneventfully. We suggest that pregnancy is possible for recipients after ABO-incompatible liver transplantation.

Keywords: ABO-incompatible; Delivery; Fulminant hepatic failure; Liver transplantation; Living donor; Pregnancy.

Publication types

  • Case Reports

MeSH terms

  • ABO Blood-Group System / adverse effects*
  • Administration, Oral
  • Adult
  • Apgar Score
  • Biopsy
  • Blood Group Incompatibility / blood
  • Blood Group Incompatibility / complications*
  • Blood Group Incompatibility / drug therapy
  • Delivery, Obstetric
  • Female
  • Hemodiafiltration
  • Hepatic Encephalopathy / blood
  • Hepatic Encephalopathy / etiology
  • Hepatic Encephalopathy / pathology
  • Hepatic Encephalopathy / therapy*
  • Hepatitis / complications*
  • Humans
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Infant, Newborn
  • Liver Transplantation / adverse effects*
  • Living Donors
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use
  • Pregnancy
  • Ribonucleosides / administration & dosage
  • Ribonucleosides / therapeutic use
  • Rituximab / administration & dosage
  • Rituximab / therapeutic use
  • Spouses
  • Tacrolimus / administration & dosage
  • Tacrolimus / therapeutic use

Substances

  • ABO Blood-Group System
  • Immunosuppressive Agents
  • Ribonucleosides
  • Rituximab
  • mizoribine
  • Tacrolimus
  • Methylprednisolone