Successful outcome after a technically challenging liver transplant during pregnancy

Area of Science:

• Hepatology
• Transplant Surgery
• Maternal-Fetal Medicine

Background:

• Liver transplantation during pregnancy is rare, with limited data on its implications.
• A 26-year-old woman with decompensated cryptogenic familial biliary cirrhosis required urgent liver transplantation.

Observation:

• The orthotopic liver transplantation (OLT) involved complex vascular reconstructions.
• A viable fetus was identified during the procedure.
• Both donor and recipient were cytomegalovirus (CMV) positive.

Findings:

• The pregnancy continued post-transplant with immunosuppression (tacrolimus, azathioprine, prednisolone).
• A healthy male infant was delivered vaginally at 36 weeks gestation.
• Both mother and child remained well at 19 months post-transplant.

Implications:

• Technically challenging OLT during pregnancy can achieve successful maternal and fetal outcomes.
• This case supports considering routine pregnancy testing for women of childbearing age awaiting or undergoing transplantation.
• Further research is needed to establish guidelines for managing pregnancy in liver transplant recipients.