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26 November 2022 : Case report  Austria

Successful Pregnancy in a Kidney-Pancreas Transplanted Patient on LifeCycle Pharma Tacrolimus (LCPT)-Based Immunosuppression

Unusual clinical course, Unusual setting of medical care

Claudia Bösmüller ORCID logo1ABCDEF*, Nikolaus Demmelbauer ORCID logo2BCE, Marlies Antlanger ORCID logo3ABE, Peter Oppelt ORCID logo4BCE, Michael Rudnicki ORCID logo5ABCE, Felix Julius Krendl ORCID logo1CE, Franka Messner ORCID logo1CE, Dietmar Öfner ORCID logo1DE, Stefan Schneeberger ORCID logo1DE, Christian Margreiter ORCID logo1DE

DOI: 10.12659/AJCR.937386

Am J Case Rep 2022; 23:e937386

Abstract

BACKGROUND: There has been, to our knowledge, no reports on LifeCycle Pharma tacrolimus (LCPT) taken during pregnancy after simultaneous pancreas-kidney transplantation (SPK). Here, we report a 25-year-old female SPK recipient who gave birth to a healthy infant in posttransplant month 32. We analyzed the long-term graft function, obstetric/neonatal course, LCPT dosage, tacrolimus (TAC) levels, concomitant medication, and complications.

CASE REPORT: Her medical history consisted of type 1 diabetes with chronic nephropathy, arterial hypertension, and atypical haemolytic uremic syndrome with critical deterioration of her general condition requiring clinically indicated early termination of her first pregnancy prior to SPK. SPK was performed according to surgical standards. The immunosuppressive prophylaxis consisted of thymoglobulin, mycophenolate mofetil, standard TAC formulation, and steroids. Due to rapid TAC metabolism, the patient was converted from a standard TAC formulation to LCPT in the first month posttransplant. Her long-term immunosuppression, including the obstetric and peripartal course, consisted of LCPT, prednisolone, and azathioprine. She was normotensive without antihypertensive medication and maintained excellent function of both grafts during the observation period of 48 months posttransplant. All (mostly infectious) complications were reversible, especially temporary polyoma viremia within normal renal function, and 2 episodes of urosepsis. No relapse of her pretransplant episode of atypical haemolytic uremic syndrome occurred posttransplant. Her child is in good health at the age of 12 months without any malformations.

CONCLUSIONS: This case suggests that pregnancy after SPK under LCPT is feasible. Further studies are needed to expand the empirical knowledge surrounding tacrolimus.

Keywords: Pregnancy, Pancreas Transplantation, Kidney Transplantation, Tacrolimus

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923