Organ transplantation and pregnancy. A case report and review

Abstract

The 1980s has been described as the "decade of transplantation" and organ transplantation as a "paradigm of medical progress." The considerable improvements in immunosuppression that have been made in the last few years have led to an increased repertoire of organ-to-organ combination transplants, more procedures, and markedly increased survival time for both grafts and recipients. Inevitably, there will be an increased number of women recipients who later undergo pregnancy. Although there is a wide experience with pregnancy after renal transplantation, there are as yet relatively few reports of pregnancy after other major organ transplants. A case is presented of a 22-year-old primiparous woman who elected to conceive and complete a pregnancy 2 years after cardiac transplantation because of cardiomyopathy. The pregnancy was complicated by a rejection episode early in the third trimester but eventually resulted in forceps delivery of a live male infant at 41 weeks' gestation. The pregnancy and organ transplantation literature is reviewed with special attention, illustrated by the case report, to the physiologic adaptation to pregnancy of the transplanted organ, the potential teratogenic effects of the immunosuppressive drugs used in pregnancy, and the contrasts between renal and other major organ transplants.