Cesarean delivery under neuraxial anesthesia in a patient with a liver transplant

Abstract

Introduction. Improved outcomes after liver transplantation contribute to a successful pregnancy and delivery in transplant recipients. Anesthesiology teams face challenges when providing perioperative care to patients who have a liver transplant and undergo cesarean delivery, which include: an increased rate of cesarean delivery, a high risk of infection, and a high risk of interaction between immunosuppressant and anesthetic drugs. Case outline. We report the case of a 28-year-old patient with a liver transplant (from a live donor) who underwent elective cesarean delivery under neuraxial anesthesia. Appropriate anesthetic management is critical to ensure optimal perioperative maternal and fetal outcomes. Cardiovascular stability after neuraxial anesthesia was maintained with adequate perioperative intravenous fluid management and early vasopressor(s) administration to preserve hepatic perfusion. Multimodal postoperative analgesia was administered; however, caution is required when prescribing drugs that have the potential for hepatic and renal side effects. Conclusion. Multidisciplinary team evaluation, planning, and preparation are vital for optimizing safe care and delivery of pregnant patients with transplanted organs.