P3262 - Pregnancy Outcomes Following Triple Organ (Small Bowel, Liver, and Pancreas) Transplantation

Award: Presidential Poster Award

Mohammed Abusuliman, MD¹, Amr Abusuliman, MD², Sheema Rehman, DO³, Ahmed Salem, MBBCh⁴, Hazem Abosheaishaa, MD⁵, Islam Mohamed, MD⁶, Moataz Aboeldahb, MD⁷, Ahmed M. Ibrahim, MD⁸, Syed-Mohammed Jafri, MD^1
1Henry Ford Health, Detroit, MI; ²Tanta University, Qutour, Al Gharbiyah, Egypt; ³Henry Ford Hospital, Detroit, MI; ⁴Maimonides Medical Center, Brooklyn, NY; ⁵Icahn School of Medicine at Mount Sinai, Queens, NY; ⁶University of Missouri - Kansas City School of Medicine, Kansas City, MO; ⁷Mayo Foundation for Medical Education and Research, Rochester, MN; ⁸Trinity Health Ann Arbor Hospital, Ypsilanti, MI

Introduction: Compared to other solid organ transplants, intestinal transplant is relatively novel, and occurrences of successful pregnancies following this procedure are considerably less common. Literature shows only 10 documented cases of successful pregnancy after intestinal transplantation, and to date, only one of which was a triple organ (intestine, liver, pancreas) transplant. We present an extremely rare case of successful pregnancy post triple gastrointestinal organ transplant.

Case Description/Methods: 20 years old, 31-week-pregnant female was evaluated by our Hepatology team for elevated liver enzymes on routine checkup. The patient had a history of small bowel, liver, and pancreas transplant at age 1 due to complicated gastroschisis at birth, and hospitalization from birth to age 4 years. She had no history of rejection and has had an uncomplicated post-transplant course. Prior to pregnancy, immune suppression was maintained with Tacrolimus, Sirolimus and Prednisone. Sirolimus and Prednisone were discontinued when the patient became pregnant, with continuation of Tacrolimus 5 mg BID, with reported medication compliance. Labs showed elevated liver enzymes: AST= 275 IU/L, ALT =228 IU/L, T. Bilirubin= 1.8 mg/dL, and FK level < 2, despite reported compliance. Ultrasound imaging revealed normal liver transplant and normal directional flow. Virology panel came back negative. Prednisone 10 mg daily was added. The patient then developed acute kidney injury, Cr:1.37, pulmonary edema, and FK went supra-therapeutic reaching 13.7 so it was held at that time.
The patient was diagnosed with preeclampsia with severe features and was taken for an uncomplicated C-section. The baby was admitted to PICU for preterm labor with initial respiratory insufficiency that later improved with no complications, discharged home 3 weeks later.
A month later, LFTs were elevated with concern for rejection. The patient had a low Tacrolimus level, reporting she was taking 3 mg daily instead of BID. High dose steroid (1 gm solumedrol for 3 days) was given, with improvement of LFTs after two doses. Tacrolimus was increased to 3 mg BID and Sirolimus was restarted. The patient is currently on Tacrolimus and Sirolimus with normal LFTs.

Discussion: Triple gastrointestinal organ transplant procedure is uncommon, and achieving a successful pregnancy afterward is even rarer. Challenges presented by pregnancy is to maintain stability of the graft, prevent infection, ensure good nutritional support and monitor fetal wellbeing and growth.


Disclosures:


Mohammed Abusuliman, MD¹, Amr Abusuliman, MD², Sheema Rehman, DO³, Ahmed Salem, MBBCh⁴, Hazem Abosheaishaa, MD⁵, Islam Mohamed, MD⁶, Moataz Aboeldahb, MD⁷, Ahmed M. Ibrahim, MD⁸, Syed-Mohammed Jafri, MD¹. P3262 - Pregnancy Outcomes Following Triple Organ (Small Bowel, Liver, and Pancreas) Transplantation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.