The advancements in transplant medicine and improved survival rates has meant that more women with solid organ transplants are able to consider pregnancy. There is limited literature in regards to complex pregnancies in multi-organ transplant patients. We present one such rare case of the first documented successful pregnancy in a patient with a heart, lung and liver transplant.
A 35-year-old female was referred for preconception care. 10 years prior, she underwent a successful heart, lung and liver transplant for complications of cystic fibrosis with no evidence of rejection. She achieved stable immunosuppression on prednisone, tacrolimus and azathioprine. Other medical history included cystic fibrosis related diabetes due to pancreatic insufficiency, hypertension (induced post transplant) and hypothyroidism. Pregnancy was achieved following IVF after 2 years of pre-conception and fertility counselling. Antenatal care included regular multi-disciplinary outpatient follow up appointments for monitoring. At week 26 she was admitted with an acute rise in creatinine and increase in proteinuria. She was assessed for preeclampsia. Careful attention was paid to her Tacrolimus levels given her steady increase in dosage required during her pregnancy. The decision to deliver was made after repeat fetal ultrasound showed abnormal doppler signals and evidence of placental insufficiency at 28 weeks. A live baby boy was delivered successfully at 28 weeks via caesarean section. Post partum course was uncomplicated with no deterioration in graft function. This case highlights the added complexities in management of multi-organ transplant patients in pregnancy.