Noninvasive Monitoring Techniques in the Pregnant Heart Transplant Patient

Thoracic transplant recipients of reproductive age are living longer, and there is growing interest in managing them through pregnancy. Fetal and maternal morbidity is high, but pregnancy and parturition can be achieved with education, risk assessment, and close monitoring.

A multidisciplinary team monitored a 27-year-old heart transplant recipient through her unplanned pregnancy with transthoracic echocardiography and testing of cell-free DNA (cf-DNA), gene expression profile (GEP), and immunosuppression levels. Total cf-DNA increased during pregnancy, donor-derived cfDNA (dd-cfDNA) remained stable, and fetal fraction percentage increased, mirroring fetal growth. As GEP and dd-cfDNA were normal, endomyocardial biopsy was not performed.

In nonpregnant heart transplant recipients, cf-DNA monitors graft health, and in obstetrics, placenta cell-free DNA screens for chromosomal anomalies. Quantifying dd-cfDNA has been described in kidney transplant recipients, however it has not been used in pregnant heart transplant recipients. This case demonstrates the utility of noninvasive cardiac allograft surveillance throughout pregnancy.

Pregnant heart transplant recipients can be monitored using the noninvasive techniques of GEP and dd-cfDNA.