tacrolimus and Budd-Chiari-Syndrome

In recent years, the number of patients undergoing liver transplant has increased. Successful transplant has resulted in better quality of life and improved fertility in younger women. This is a case study a 31-year-old woman, who had history of Budd-Chiari syndrome and underwent liver transplantation in 2014 with uneventful postoperative course. She was clinically stable on tablet tacrolimus and coumarin with no episode of allograft rejection since transplantation. The patient conceived spontaneously, after 4 years of transplant and during pregnancy, she was managed by multidisciplinary team. During the initial period, the graft and pregnancy continued without complications. However, at 33 weeks, the patient presented with sluggish fetal movements, amniotic fluid index of 3.4 and SD ratio of 3.31 for which she underwent caesarean section. She delivered a healthy female baby of 1.4 kg. This case study concludes that vigilant monitoring of fetal growth is pivotal for optimal fetal outcome.

Topics: Adult; Budd-Chiari Syndrome; Cesarean Section; Coumarins; Female; Humans; Liver Transplantation; Pregnancy; Pregnancy Outcome; Tacrolimus

Topics: Acute Disease; Anemia, Sickle Cell; Antisickling Agents; beta-Thalassemia; Bradycardia; Budd-Chiari Syndrome; Cardiopulmonary Resuscitation; Cholestasis, Intrahepatic; Glucocorticoids; Graft Rejection; Heart Arrest; Humans; Hydroxyurea; Immunosuppressive Agents; Liver Failure, Acute; Liver Transplantation; Male; Postoperative Complications; Prednisone; Tacrolimus; Young Adult

The Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction involving the hepatic veins, inferior vena cava, or both. BCS has occasionally been reported in the literature as a very rare complication of ulcerative colitis. However, association of Crohn's disease (CD) and BCS is extremely rare with only a single case reported in the world literature to date. We report a case of a young woman with chronically active, therapy-resistant CD who developed massive ascites, elevation of liver enzymes, and coagulopathy in the course of her disease. She was subsequently diagnosed with BCS for which a successful liver transplantation was performed. Chronically active therapy resistant CD and methylenetetrahydrofolate reductase gene mutation have been identified as possible risk factors for development of BCS in this patient.

Topics: Adrenal Cortex Hormones; Ascites; Budd-Chiari Syndrome; Crohn Disease; Female; Hepatic Veins; Humans; Immunosuppressive Agents; Liver; Liver Transplantation; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Phlebography; Risk Factors; Tacrolimus; Tomography, X-Ray Computed; Vena Cava, Inferior; Warfarin; Young Adult