Work

Occurrence and recurrence of hepatocellular carcinoma in patients with HCV genotype 1b related cirrhosis treated with Ledipasvir + Sofosbuvir ± Ribavirin

Year: 2020

Type: article

Abstract: Pregnancy in a liver transplant patient treated with everolimus and tacrolimusTo the Editor,We appreciated the paper regarding the quality of life in patients after liver transplantation (LT) by Domingos et al. [1], recently published in the Journal of Gastrointestinal and Liver Diseases.The authors reported a similar or superior quality of life in LT patients compared to the general population.Due to advances in immunology and transplant medicine, women with a history of LT could have successful pregnancies.However, data on pregnancy outcomes is still limited, especially for women with a history of liver graft failure, receiving the mammalian target of rapamycin (mTOR) inhibitors.Recently, many studies focused on everolimus benefits in the immunosuppression regimen after LT, which might be initiated early post-LT or in later monitoring phases, allowing the calcineurin inhibitor reduction [2].Published reports on pregnant women exposed to tacrolimus documented no increased risk of malformations, but data on pregnancy under everolimus is still relatively scarce [3, 4].We report a good clinical outcome of an unplanned pregnancy in a LT female patient aged 30 under everolimus and tacrolimus immunosuppression therapy.The patient had a successful LT at 20-year old for decompensated liver cirrhosis caused by Wilson disease.The recipient received tacrolimus as immunosuppressive therapy for 5 years with stable graft liver function.In 2016, at 25-years old, she had an unplanned pregnancy discovered at 8 weeks of gestation.The immunosuppressive therapy was reduced and then completely stopped by the patient herself, during the second semester of pregnancy.At 27 weeks of pregnancy she was admitted in the hospital with high levels of bilirubin (total bilirubin 10.7 mg/dl, conjugated bilirubin 9 mg/dl, upper normal value 1 mg/dl), mild cholestasis and elevated aminotransferase levels (8 times the upper normal limit).The liver biopsy depicted mild mononuclear inflammatory infiltrate in the portal space with disappearance of bile ducts and

Source: Journal of Gastrointestinal and Liver Diseases

DOI: 10.15403/jgld-3148