Successful pregnancy following a lung transplant

Abstract

A 27-year-old primiparous lady attended the high risk medical obstetric clinic for antenatal booking at 13 weeks gestation. She had a successful single lung transplantation performed 5 years previously because of severe cryptogenic fibrosing alveolitis. She had also required treatment for hypertension in recent years, possibly related to her cyclosporin immunosuppressive therapy. There was a family history of essential hypertension as her father required treatment at the age of 65. Her current medication included cyclosporin 150 mg twice daily, azathioprine 150 mg daily, propranolol 40 mg twice daily and a salbutamol inhaler as required. Urinalysis was negative and her blood pressure was well controlled at 123/91 mmHg. Baseline renal function was normal and her blood cyclosporin level of 172 ng/ml (therapeutic range 95-205 ng/ml). A detailed fetal anatomy scan performed at 19 weeks gestation was unremarkable. Close maternal and fetal monitoring were carried out throughout the pregnancy. Pulmonary function testing at 25 weeks gestation confirmed a stable restrictive defect with a forced expiratory volume in 1 second (FEV1) of 1.3 1 (42% expected), a forced vital capacity (FVC) of 1.6 1 (41% expected) and a peak expiratory flow rate (PEFR) 300 1/min (69% expected). At 26 weeks gestation antenatal admission was required because of an increase in blood pressure and the development of proteinuria. Methyldopa and nifedipine were initially used to control her blood pressure but neither was well tolerated. Prazosin was added to a reduced methyldopa dose with reasonable effect over the following week. Fetal growth remained satisfactory at the 40th centile with normal umbilical