Successful pregnancy after Budd-Chiari syndrome

Pregnancy in women with known and treated Budd-Chiari syndrome: maternal and fetal outcomes

BACKGROUND/AIMS

Budd-Chiari syndrome (BCS) mainly affects women of childbearing age. We aimed to clarify whether pregnancy, a thrombotic risk factor, should be contraindicated in patients with known and treated BCS.

METHODS

A retrospective study of pregnancy in women with known and treated BCS.

RESULTS

Sixteen women had 24 pregnancies. Nine women had undergone surgical or radiological treatment. Anticoagulation was administered during 17 pregnancies. Seven fetuses were lost before gestation week 20. Deliveries occurred between week 20 and 31 in two patients, week 32 and 36 in eleven and after week 37 in four. There was one stillbirth, but 16 infants did well. Factor II gene mutation was a factor for a poor outcome of pregnancies. In two patients, symptomatic thrombosis recurred during pregnancy or postpartum. All patients were alive after a median follow-up of 34 months after the last delivery. Bleeding at delivery, although non-lethal, occurred only on anticoagulation therapy.

CONCLUSIONS

When known and treated BCS is well controlled, pregnancy should not be contraindicated as maternal outcome, and fetal outcome beyond gestation week 20, are good. The risk-benefit ratio of anticoagulant therapy needs to be further clarified. Patients should be fully informed of the persistent risks of such pregnancies.

Vascular disorders of the liver

This guideline has been approved by the American Association for the Study of Liver Diseases (AASLD) and represents the position of the association.

Gender-Specific Issues in Liver and Kidney Failure and Transplantation: A Review

INTRODUCTION

Historically, research has been performed in male animals and extrapolated to the care of females regardless of biological differences. Men and women differ, however, with regard to severity and pathogenesis of disease and healthcare needs and this uniform approach, regardless of gender, is not always in the best interests of the patient. The relationship between sex hormones and immunological processes has been extensively documented but is not yet well understood and these differences will be discussed as they relate to liver and kidney failure and transplantation.

DISCUSSION

Certain forms of organ failure are more common in either men or women and the physiological changes associated with pregnancy present unique challenges to the transplant physician since pregnancy may adversely affect graft function and immunosuppression presents a risk for opportunistic infection in the mother or fetal injury. Donor and recipient gender affect graft and patient survival after transplantation and there is clearly some gender bias in organ donation and transplantation.

CONCLUSIONS

We need to be mindful of these differences in relation to gender-specific diseases, hormonal and immunological differences in designing clinical protocols and treatment pathways in order to improve outcomes in transplantation. Unfortunately, this is difficult in an environment where our practice is largely restricted by a shortage of donor organs and the need to decrease waiting list mortality.

Hepatic emergencies in pregnancy

Although liver disease during pregnancy is a rare event, it can have devastating effects on the mother and the child. This article reviews diseases uniquely associated to pregnancy, such as fatty liver of pregnancy, toxemia, and others. It also details new advances in diseases such as viral hepatitis and pregnancy and intrahepatic cholestasis of pregnancy.

Results of portal systemic shunts in Budd-Chiari syndrome

Nine patients with Budd-Chiari syndrome (BCS) were treated by a portal systemic shunt. One had thrombosis of the superior mesenteric vein (SMV) and another had complete obstruction of the retrohepatic inferior vena cava (IVC). All other patients had a marked stenosis of the retrohepatic IVC with caval pressure ranging from 12 to 24 mmHg (mean: 17 mmHg). Seven patients had an interposition mesocaval shunt using an autologous jugular vein. The patient with a thrombosed SMV had a portoatrial shunt. The patient with an obstructed IVC had a cavoatrial shunt after an erroneous portacaval shunt had failed to relieve ascites. There were no operative deaths and no major postoperative complications. One patient died 19 months after operation of acute leukemia complicating polycythemia rubra vera. All other patients were alive and well 8 months to 6 years after operation. None of them had encephalopathy. These results suggest several comments: Portal systemic shunts are a good treatment for BCS and have a low operative risk. The mesocaval shunt is an efficient procedure, even when there is stenosis of the IVC with high caval pressure; shunts to the right atrium should be performed only in the case of complete obstruction or inaccessibility of the IVC. The long-term prognosis is excellent, except in patients with potential malignancies. Therefore, portal systemic shunts should be indicated early in patients with symptomatic BCS.