Liver transplantation during pregnancy complicated by cytomegalovirus infection

Transplantation for end-stage liver disease is now an established therapy and increasing numbers of patients are surviving long term. Many of these are women of reproductive age and there are several reports in the literature of pregnancy following liver and other organ transplantation with, in general, a good outcome. In 4 patients with fulminant hepatic failure, liver transplantation was performed during pregnancy, and although all the women are alive and well, only 2 of the fetuses survived. We report a successful outcome for both mother and child in a woman who was transplanted following a sudden deterioration in previously stable chronic liver disease and who at laparotomy had a hitherto unsuspected 20-week pregnancy. The postoperative course was complicated by active CMV infection in the mother. We discuss the management of the pregnant transplant patient, particularly with regard to the treatment of CMV.