Pregnancy and delivery after liver transplantation

The first case of pregnancy in a patient after an orthotopic liver transplantation (OLT) in Poland is presented. A 21-year-old woman was liver grafted 3 years prior to the pregnancy. Before having conceived the patient's graft function was stable. The woman was on immunosuppressive therapy with cyclosporine A and prednisolone. During pregnancy no significant changes in biochemical tests of liver function and liver blood flow were noted. Starting at the second trimester, a slight anemia occurred and the quantity of blood platelets continued to decrease, the latter having been observed immediately after the transplantation. The intrauterine growth of the fetus was monitored by ultrasound and the assessment of blood flow to the placenta was made. No abnormality was observed. In the second and third trimester the presence of HCV-RNA in the serum was found. In the 41-st week of pregnancy labor commenced. The threat of intrauterine infection indicated a cesarean delivery. The newborn weighed 4180 g and had an Apgar score of 10. The cesarean section, as well as puerperium, was normal. The immunosuppressive therapy was continued, and antibiotics were administered for prophylactic reasons. During the first month the infant was treated with antibiotics because of pneumonia and the suspicion of meningitis. Nine months after the delivery, the patient's health is satisfactory and the baby is making normal progress.