Our Summary

This research paper discusses the subject of pregnancy after organ transplantation, specifically focusing on intestinal/multivisceral transplantation. Over the last 20 years, there have been significant improvements in the survival of both the graft (transplanted organ) and the patient after such a procedure. In the past decade, there have been eight reported cases of successful pregnancies following this type of transplant, all of which resulted in live births. However, there are two key considerations in the case of pregnancy: the functioning of the transplanted bowel and the increased need for immune-suppressing drugs. Monitoring the health of the patient and the transplanted organ can help prevent health issues during pregnancy, such as rejection of the transplant or inflammation of the intestines, which could potentially harm the fetus. As more patients are surviving and regaining their ability to reproduce after intestinal transplantation, it is important to make women and healthcare professionals aware of this possibility.

FAQs

  1. Can a woman become pregnant after having an intestinal/multivisceral transplant?
  2. What factors should be considered during pregnancy after an intestinal transplant?
  3. What measures need to be taken to prevent episodes of rejection or enteritis during pregnancy after an intestinal transplant?

Doctor’s Tip

A doctor may advise a patient who has undergone an intestinal transplant and is considering pregnancy to closely monitor their renal function and graft health during pregnancy. It may also be necessary to adjust immune-suppressant medications to ensure the health of both the mother and fetus. Regular endoscopies and biopsies may be recommended to prevent rejection episodes or enteritis, and to ensure the fetus is not affected by temporary malnutrition. It is important to communicate with healthcare professionals about the possibility of pregnancy after intestinal transplantation.

Suitable For

Intestinal transplant patients who are stable and have good graft function are typically recommended for pregnancy. It is important for these patients to be closely monitored during pregnancy due to the absorptive function of the transplanted bowel and the higher need for immune-suppressants. Close monitoring of renal function and the graft by endoscopies and biopsies may be necessary to prevent rejection or enteritis episodes during pregnancy. As more intestinal transplant patients are surviving and regaining reproductive function, it is important for healthcare professionals to discuss the option of pregnancy with female recipients.

Timeline

  • Before intestinal transplant: The patient is likely suffering from intestinal failure, often due to conditions such as short bowel syndrome, Crohn’s disease, or motility disorders. They may be experiencing severe malnutrition, dehydration, and frequent hospitalizations. The patient undergoes extensive medical evaluations to determine if they are a suitable candidate for transplant.

  • Day of transplant: The patient undergoes a complex surgical procedure to remove the diseased intestine and replace it with a healthy donor intestine. The surgery can last several hours and carries risks of complications such as infection, rejection, and organ failure.

  • Post-transplant recovery: The patient is closely monitored in the hospital for signs of rejection or infection. They will require intensive medical care, including immune-suppressant medications to prevent rejection of the new organ. The patient may experience complications such as graft-versus-host disease, infections, or post-operative complications.

  • Months to years after transplant: The patient continues to be monitored closely by their medical team to ensure the health of the transplanted intestine. They may require ongoing immune-suppressant medications and regular follow-up appointments. The patient may experience improvement in their quality of life, such as better nutrition absorption and reduced hospitalizations.

  • Pregnancy after transplant: If the patient is a female recipient of an intestinal transplant, they may consider pregnancy after consultation with their medical team. Close monitoring of the transplanted organ and immune-suppressant levels is essential during pregnancy to prevent rejection and ensure the health of both the mother and fetus. Successful pregnancies have been reported in female intestinal transplant recipients, with careful management of the pregnancy and transplant.

What to Ask Your Doctor

  1. How will the immune-suppressant medications I am taking affect my ability to conceive and carry a pregnancy to term?
  2. What impact will the transplanted bowel have on my ability to absorb nutrients necessary for a healthy pregnancy?
  3. How often will I need to undergo monitoring of my renal function and the graft during pregnancy to prevent rejection or complications?
  4. Are there any specific precautions or interventions that should be taken during pregnancy to ensure the health of both the mother and the fetus?
  5. Are there any potential risks or complications associated with becoming pregnant after an intestinal transplant that I should be aware of?
  6. Will I need to adjust my immune-suppressant medications during pregnancy, and if so, how will this be managed?
  7. Are there any lifestyle changes or dietary considerations I should be aware of in order to support a healthy pregnancy post-transplant?
  8. What is the likelihood of a successful pregnancy and live birth after an intestinal transplant, based on my individual health status and medical history?
  9. Are there any additional resources or support services available for intestinal transplant patients who are considering or currently pregnant?
  10. What long-term considerations should I be aware of regarding pregnancy and childbirth after an intestinal transplant?

Reference

Authors: Lauro A, Matsumoto CS, Marino IR, Berghella V. Journal: J Matern Fetal Neonatal Med. 2017 Jan;30(2):205-212. doi: 10.3109/14767058.2016.1168801. Epub 2016 Apr 14. PMID: 27003598