小肠、胰腺和肝脏移植受者的妊娠管理和结果:病例报告与文献综述。

IF 1 Q3 MEDICINE, GENERAL & INTERNAL American Journal of Case Reports Pub Date : 2024-11-15 DOI:10.12659/AJCR.945914
Mohammed Abusuliman, Abdullah Olimy, Moataz Aboeldahb, Amr Abusuliman, Sanad Dawod, Sheema Rehman, Ahmed E Salem, Sarah Meribout, Khalid Aloum, Syed-Mohammed Jafri
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引用次数: 0

摘要

背景 小肠移植(SBT)是一种罕见的救命手术。然而,由于这种移植手术给妊娠带来了营养和免疫抑制方面的挑战,SBT 患者成功足月妊娠的情况极为罕见。因此,目前尚无治疗妊娠 SBT 受者的明确指南。在此,我们报告了第二例三器官移植(包括 SBT)受者成功怀孕的病例,强调了谨慎的免疫抑制管理和多学科护理的必要性。病例报告 一位 20 岁的女性在怀孕三个月时,因肝功能检测结果升高而前来就诊,她在 1 岁时曾接受过小肠、肝脏和胰腺移植手术。她在怀孕前一直服用他克莫司、西罗莫司和泼尼松,没有出现器官排斥的迹象。虽然怀孕后停用了西罗莫司和泼尼松,但就诊时的化验结果显示血清他克莫司水平较低。住院期间,患者出现急性肾损伤和肺水肿,被诊断为子痫前期。由于引产并发症,她成功地进行了剖宫产;然而,出院后约 1 个月,患者出现肝酶升高,经大剂量类固醇和调整他克莫司治疗后好转。重新开始使用西罗莫司后,患者的肝酶至今已恢复正常。结论 在整个产前、围产期和产后期间,全面的多学科护理以及监测和优化免疫抑制对妊娠 SBT 受体至关重要,可降低风险、预防移植物排斥反应并确保孕产妇和胎儿的健康。
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Pregnancy Management and Outcomes in a Small Bowel, Pancreas, and Liver Transplant Recipient: A Case Report and Literature Review.

BACKGROUND Small bowel transplantation (SBT) is a rare but life-saving surgery. However, successful full-term pregnancies in individuals with SBT are exceedingly rare due to the nutritional and immunosuppression challenges this transplant poses for pregnancy. Therefore, clear guidelines for treating pregnant SBT recipients are unavailable. Here, we report the second case of a successful pregnancy in an individual with a triple organ transplant, including SBT, highlighting the need for careful immunosuppressive management and multidisciplinary care. CASE REPORT A 20-year-old woman in the third trimester of pregnancy with a history of small bowel, liver, and pancreas transplantation at age 1 year presented with elevated liver function test results. She had been taking tacrolimus, sirolimus, and prednisone before pregnancy, with no signs of organ rejection. While sirolimus and prednisone was discontinued upon conception, laboratory test results at presentation revealed low serum tacrolimus levels. The patient had an acute kidney injury and pulmonary edema during her hospitalization and received a diagnosis of preeclampsia. She underwent a successful cesarean delivery, due to labor induction complications; however, about 1 month after hospital discharge, the patient experienced elevated liver enzymes, which was treated with high-dose steroids and adjusted tacrolimus. Sirolimus was restarted, and the patient's liver enzymes have been normalized to date. CONCLUSIONS Comprehensive multidisciplinary care, as well as monitoring and optimizing immunosuppression, are essential for pregnant SBT recipients throughout the prenatal, perinatal, and postpartum periods to mitigate risks, prevent graft rejection, and ensure positive maternal and fetal health outcomes.

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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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