Pregnancy in Liver and Kidney Female Recipient: A Case Report

Abstract

Deterioration of kidney function after orthotopic liver transplantation is a common complication. It may occur due to perioperative acute kidney injury (AKI) and pre-existing or developing chronic kidney disease (CKD). AKI is described in early postoperative period in more than half of the recipients whereas the main cause of CKD is pharmacotherapy. When end-stage renal failure occurs, patients may be qualified for additional transplantations.A case report: We present a rare case of 27-year-old female who as teenager underwent two liver transplantations due to Wilson's disease. Operations were complicated by systemic infection and multiple organ failure. The kidneys did not regain their function, therefore, after 6 months of dialysis, the organ was transplanted. In total, three organ transplantations were performed. Due to the patient's willingness and good graft functions, patient started trying to conceive. Three months before successful conception, immunosuppressive therapy was changed to tacrolimus and azathioprine. Pregnancy was complicated by pregnancy induced hypertension and its course was closely monitored. Organs' functions and immunosuppressive therapy were regularly assessed. Due to the pre-eclampsia developed in the 35th week of gestation, a caesarean section was performed and she gave birth to daughter weighing 2350g (Apgar 7-7-8). Women decided on breastfeeding. No obstetric complications or graft function deterioration were observed in the early postpartum period. Mother and daughter left home after 7 days of hospitalization.Conclusions: The presented clinical situation proves that successful pregnancy is possible by multi-organ transplantation recipients, without impairing the graft functions. Therefore, it requires adequate preparation and increased care.