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Urgent Liver Transplantation for Acute Liver Failure in Pregnant Women: The Optimum Timing for Delivery. Transplantation 2023; 107:172-180. [PMID: 36042543 DOI: 10.1097/tp.0000000000004290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The occurrence of acute liver failure (ALF) in pregnant women due to an etiology unrelated to pregnancy (pregALF) that leads to liver transplantation (LT) has rarely been reported. The objective was to report the outcome of pregnant women and fetus and propose a strategy for the timing of delivery and of LT in these patients. METHODS Five consecutive pregnant patients with ALF were admitted to our center between 1986 and 2018 and underwent an LT. A systematic review of case reports concerning patients with pregALF who underwent LT was extracted from the literature. RESULTS Three with gestational ages (GA) at admission of 15, 22, and 31 weeks of gestation (WG) were transplanted after delivery (n = 1) or intrauterine demise (n = 2) and 2 with GA of 16 and 23 WG before delivery. One infant survived in each group. Among the 32 cases published previously, 11 (34%) had been transplanted after delivery (median GA:31 [28-33]); 10 of these 11 infants were alive at birth. The other 21 mothers were transplanted before delivery (GA:21 WG [18-22]). The median GA at delivery was 30 WG [27.75-37]. Twelve of 21 infants were alive at birth. One-year survival among the ALF patients in our series and in the literature was 100%. Overall, the perinatal survival rate was low (64.8%). CONCLUSIONS In pregnant patients presenting with ALF not related to the pregnancy, the LT lifesaving procedure had an excellent outcome. Overall, 65% of the infants were alive at delivery with major mortality in those fetus <22 WG despite continued pregnancy.
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2
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Romano DN, Mokuolu DC, Katz DJ, DeMaria S. Orthotopic liver transplant in the pregnant recipient: A systematic review of preoperative management and maternal and fetal outcomes. Clin Transplant 2021; 35:e14269. [PMID: 33615548 DOI: 10.1111/ctr.14269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022]
Abstract
Severe liver dysfunction requiring transplantation is a major event at any stage of life, but for those requiring liver transplantation while pregnant, two lives hang in the balance. Available evidence on this relatively rare event consists solely of case reports and have yet to be reviewed or synthesized. We performed a systematic literature review and analyzed reports of 22 patients who underwent liver transplantation during pregnancy. This review describes the reported etiologies of hepatic failure in pregnant patients requiring transplantation, perioperative anesthetic management techniques, and the maternal and fetal clinical outcomes.
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Affiliation(s)
- Diana N Romano
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Liver Transplant Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debbie C Mokuolu
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel J Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Obstetric Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Liver Transplant Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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3
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Ziogas IA, Hayat MH, Tsoulfas G. Obstetrical and gynecologic challenges in the liver transplant patient. World J Transplant 2020; 10:320-329. [PMID: 33312893 PMCID: PMC7708880 DOI: 10.5500/wjt.v10.i11.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
An increasing number of childbearing agewomen undergo liver transplantation (LT) in the United States. Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility, particularly in terms of immunosuppression and optimal timing of conception. Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. Counseling on pregnancy should start before LT and continue after LT up until pregnancy, while all pregnant LT recipients must be managed by amultidisciplinary team, including both an obstetrician and a transplant hepatologist. Additionally, an interval of at least 1-2 years after successful LT is recommended before considering pregnancy. Pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients. As adverse fetal outcomes, such asmiscarriage, abortion, stillbirth, or ectopic pregnancy, may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications. No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.
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Affiliation(s)
- Ioannis A Ziogas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Muhammad H Hayat
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Georgios Tsoulfas
- Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
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4
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Malherbe JAJ, Garas G, Khor TS, MacQuillan GC. Delayed Fulminant Hepatic Failure from Dydrogesterone-Related In Vitro Fertilization Therapy Requiring Liver Transplantation During Pregnancy. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925690. [PMID: 32938902 PMCID: PMC7520868 DOI: 10.12659/ajcr.925690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Female, 35-year-old Final Diagnosis: Fulminant liver failure Symptoms: Coagulopathy • hepatic encephalopathy • jaundice Medication:— Clinical Procedure: Liver transplantation Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Jacques A J Malherbe
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia
| | - George Garas
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia.,Western Australia Liver Transplantation Service, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Tze S Khor
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Gerry C MacQuillan
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia.,Western Australia Liver Transplantation Service, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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5
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Abstract
Hepatitis E virus (HEV) infection has distinct features, depending upon the genotype and geographical area. HEV genotypes 1 and 2 are endemic to various developing countries causing epidemics of acute viral hepatitis with human to human transmission. On the other hand, HEV genotypes 3 and 4 prevalent in developed countries commonly lead to subclinical infection and are transmitted zoonotically. HEV infection typically causes acute self-limiting illness associated with low morbidity and mortality. Infection with HEV genotype 1 or 2 in pregnancy, especially in the third trimester may lead to severe illness and fulminant liver failure. Poor maternal and fetal outcomes have been reported. Areas covered: This review highlights the various aspects of HEV infection in pregnancy including diagnosis, management, and prevention. Expert commentary: Treatment is mainly supportive with diligent monitoring and intensive care. Therapeutic termination of pregnancy cannot be recommended based to the available literature. Early liver transplantation (LT) should be considered in these patients although the indications and timing of LT are still controversial. Prevention of HEV infection or illness by improved sanitation and active/passive immunization needs further research.
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Affiliation(s)
- Premashis Kar
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital , Ghaziabad , India
| | - Anando Sengupta
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital , Ghaziabad , India
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6
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Bartnik CM, Maheshwari RN, Subramanian RM. Beating the Odds: A Full-Term Delivery After Liver Transplantation of a Pregnant Hyperthyroid Patient at 19 Weeks' Gestation for Propylthiouracil-Induced Acute Liver Failure. Transplant Proc 2018; 50:3995-3999. [PMID: 30577302 DOI: 10.1016/j.transproceed.2018.06.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/27/2018] [Indexed: 12/21/2022]
Abstract
Liver transplantation (LT) for acute liver failure is an uncommon occurrence in the setting of pregnancy given the risk of fetal demise, and rarely is it undertaken with a viable fetus. Maternal hyperthyroidism increases fetal risk in the setting of LT, particularly in the setting of thyrotoxicosis. We report the first case of propylthiouracil-induced acute liver failure in a hyperthyroid patient in her second trimester resulting in LT. The multidisciplinary management led to a favorable outcome for the patient and the subsequent delivery of a healthy infant at 38-weeks' gestation.
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Affiliation(s)
- C M Bartnik
- Division of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - R M Subramanian
- Division of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Gastroenterology and Hepatology, Emory University School of Medicine, Atlanta, Georgia.
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7
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Pandey CK, Karna ST, Pandey VK, Tandon M. Acute liver failure in pregnancy: Challenges and management. Indian J Anaesth 2015; 59:144-9. [PMID: 25838585 PMCID: PMC4378074 DOI: 10.4103/0019-5049.153035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Acute liver failure (ALF) in pregnancy negatively affects both maternal and foetal outcome. The spectrum of liver disease in pregnancy may range from mild asymptomatic transaminitis to fatal and irreversible deterioration in liver functions leading to significant morbidity and even mortality. In this comprehensive review, we searched articles published as review articles, clinical trials, and case series in the Medline from 1970 to 2012. The overall outcome of ALF in pregnancy depends on the aetiology, timely diagnosis, prompt management, and early referral to a centre equipped in managing medical or obstetric complication. The foetal outcome is affected by the stage of pregnancy in which the mother has a deterioration of the liver function, with a worst prognosis associated with first or second-trimester liver failure. When ALF complicates pregnancy, liver transplantation is the one of the viable options. Management protocols need to be individualised for each case keeping in mind the risk versus benefit to both the mother and the foetus.
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Affiliation(s)
- Chandra Kant Pandey
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Sunaina Tejpal Karna
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Vijay Kant Pandey
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Manish Tandon
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
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8
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Franko KR, Mekeel KL, Woelkers D, Khanna A, Hemming AW. Accidental acetaminophen overdose results in liver transplant during second trimester of pregnancy: a case report. Transplant Proc 2014; 45:2063-5. [PMID: 23769109 DOI: 10.1016/j.transproceed.2012.10.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 10/30/2012] [Indexed: 12/21/2022]
Abstract
Acetaminophen overdose is the most rapidly growing cause of fulminant hepatic failure in Western countries. Pregnant women are counseled that acetaminophen is safe during pregnancy and an alternative to nonsteroidal anti-inflammatory medications. This report describes a case of acetaminophen overdose during the second trimester of pregnancy with resultant fulminant hepatic failure requiring liver transplantation. The fetus was previable at the time of liver transplantation, and methods to preserve viability during and after transplantation are discussed. Despite the best attempts of the team, the fetus expired. The challenges and outcomes of fulminant hepatic failure in pregnancy are discussed in detail.
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Affiliation(s)
- K R Franko
- Department of Transplant and Hepatobiliary Surgery, University of California at San Diego, CA 92103, USA.
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9
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Liver Transplantation during Pregnancy for Acute Liver Failure due to HBV Infection: A Case Report. Case Rep Obstet Gynecol 2013; 2013:356560. [PMID: 24383021 PMCID: PMC3872232 DOI: 10.1155/2013/356560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/28/2013] [Indexed: 12/31/2022] Open
Abstract
Acute hepatic failure during pregnancy is a life-threatening situation for the mother and fetus and might need a super-urgent liver transplantation. Many pregnancies with positive outcomes are reported after a previous liver transplantation before the pregnancy, but only a few of them are mentioned with transplantation during pregnancy. In these few cases, fetal outcome is mostly adverse. Experience with liver failure during pregnancy and its management is still deficient and needs to be approved. For sure, patients need to be treated in highly qualified centers in a multidisciplinary approach. We present a case of successful super-urgent liver transplantation during the second trimester of pregnancy after acute hepatic failure due to an acute hepatitis B infection with positive maternal and fetal outcome. Liver transplantation during pregnancy due to an acute liver failure can be a life-saving procedure for the mother and fetus. An early initiated maternal therapy with antiviral drugs and immunoglobulins seems to be safe and able to prevent fetal infection and immunosuppressive therapy after transplantation seems to be well tolerated. Nevertheless, fetal outcome differs widely and long-term outcome is deficiently known.
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10
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Acute Liver Failure Occurring during the First Trimester of Pregnancy Successfully Treated with Living Donor Liver Transplantation. Case Rep Transplant 2013; 2013:309545. [PMID: 24368963 PMCID: PMC3867862 DOI: 10.1155/2013/309545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/13/2013] [Indexed: 02/02/2023] Open
Abstract
Acute liver failure (ALF) during pregnancy remains difficult to treat, and despite advances in treatment, liver transplantation must be selected as treatment option in certain cases. We report a 30-year-old woman with ALF of unknown etiology, occurring during the first trimester of pregnancy. Her condition was complicated by consciousness disturbance and coagulopathy due to ALF, but she was successfully treated with living donor liver transplantation 7 days after dilatation and curettage. At 9-month followup, she was in good medical condition. Liver transplantation has been reported as one of the treatment options for ALF during pregnancy with the prognosis varying depending on the trimester, from living donor or deceased donor liver transplantation. Of importance is that clinicians always think of emergent liver transplantation as a therapeutic option in ALF even in the first trimester of pregnancy.
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11
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Liver transplantation for acute liver failure at 11-week gestation with successful maternal and fetal outcome. Case Rep Transplant 2012; 2012:484080. [PMID: 23227416 PMCID: PMC3513828 DOI: 10.1155/2012/484080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/24/2012] [Indexed: 12/27/2022] Open
Abstract
Acute liver failure (ALF) during pregnancy is very uncommon. Pregnancy-specific liver conditions like hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and acute fatty liver of pregnancy can cause ALF at term or postpartum, but, typically occur during the third trimester. Most of these patients recover spontaneously after delivery, but, on occasion, they require liver transplantation in the postpartum period. However, ALF during the first and second trimester of pregnancy requiring antepartum liver transplantation is rare. Only fifteen cases of liver transplantation during pregnancy have been reported, and very few occurred during the first trimester. We report a Woman who developed acute liver failure during the first trimester of pregnancy and underwent successful liver transplantation at 11-week gestation, followed by successful delivery of the fetus at 30 weeks. To our knowledge, this is the earliest case of successful liver transplantation during pregnancy followed by successful fetal outcome. We discuss management of the patient and fetus before, during, and after liver transplantation and review the literature on antepartum liver transplant in pregnancy.
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12
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Mouloudi E, Vasiliadis T, Aslanidis T, Karapanagiotou A, Papanikolaou V, Gritsi-Gerogianni N. Preterm Delivery in a Parturient Candidate for Emergency Liver Transplantation After Hepatitis B Virus Infection Related Fulminant Liver Failure. Transplant Proc 2012; 44:2765-7. [DOI: 10.1016/j.transproceed.2012.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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García NIS, Morant JCG, González EH. Cirugía no obstétrica durante el embarazo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2011. [DOI: 10.5554/rca.v39i3.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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Goarin AC, Homer L. [Liver transplantation and pregnancy]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2010; 39:529-36. [PMID: 20144511 DOI: 10.1016/j.jgyn.2010.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 12/31/2009] [Accepted: 01/12/2010] [Indexed: 11/27/2022]
Abstract
Management during their sexual life of patients with a liver transplantation is a more or less common situation depending centers. Based on literature review, a focus on management of recipient women was conducted, from contraception to pregnancy, describing the complications related to the status of transplant recipient, but also those that may be related to immunosuppressive agents. If fertility and access to contraception are only slightly modified by graft, complications related to graft or immunosuppressive drugs can affect the pregnancy. On the maternal side, hypertension and preeclampsia are more common, as well as renal dysfunction, iatrogenic diabetes and bacterial or viral infections, acute rejection and graft loss do not appear to be influenced by pregnancy. The fetus is also exposed to risks such as induced prematurity and IUGR. Pregnancy in recipients of hepatic grafts therefore requires joint follow-up by transplant specialist and perinatologist, which leads in most cases to successful outcome for mother and child.
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Affiliation(s)
- A-C Goarin
- Service de gynécologie obstétrique et médecine de la reproduction, hôpital Morvan, CHU de Brest, 2, avenue Foch, 29609 Brest, France
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15
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Toti L, Manzia TM, Romano P, Lenci I, Baiocchi L, Anselmo A, Sforza D, Manuelli M, Tisone G. Successful management of a same-day emergency delivery and liver transplant in a 27 weeks pregnant woman with fulminant hepatic failure. Transpl Int 2010; 23:114-5. [PMID: 19619174 DOI: 10.1111/j.1432-2277.2009.00908.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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16
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Greenberg M, Daugherty TJ, Elihu A, Sharaf R, Concepcion W, Druzin M, Esquivel CO. Acute liver failure at 26 weeks' gestation in a patient with sickle cell disease. Liver Transpl 2009; 15:1236-41. [PMID: 19790148 DOI: 10.1002/lt.21820] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Orthotopic liver transplantation (OLT) for acute liver failure (ALF) during pregnancy is an uncommon occurrence with variable outcomes. In pregnancy-related liver failure, prompt diagnosis and immediate delivery are essential for a reversal of the underlying process and for maternal and fetal survival. In rare cases, the reason for ALF during pregnancy is either unknown or irreversible, and thus OLT may be necessary. This case demonstrates the development of cryptogenic ALF during the 26th week of pregnancy in a woman with sickle cell disease. She underwent successful cesarean delivery of a healthy male fetus at 27 weeks with concurrent OLT. This report provides a literature review of OLT in pregnancy and examines the common causes of ALF in the pregnant patient. On the basis of the management and outcome of our case and the literature review, we present an algorithm for the suggested management of ALF in pregnancy.
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Affiliation(s)
- Mara Greenberg
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94304-1510, USA
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17
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Armenti VT, Constantinescu S, Moritz MJ, Davison JM. Pregnancy after transplantation. Transplant Rev (Orlando) 2008; 22:223-40. [PMID: 18693108 DOI: 10.1016/j.trre.2008.05.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The National Transplantation Pregnancy Registry (NTPR) was established in 1991 to study the outcomes of pregnancies in female transplant recipients and pregnancies fathered by male transplant recipients. Data from the NTPR have helped to endorse the reassurances from publications of smaller experiences that successful pregnancies are possible in the transplant population. In our last review for this journal (2000), we noted that important future issues would include the reassessment of prepregnancy guidelines, gestational and organ-specific problems, the role of new immunosuppressive drugs, and the long-term effects of pregnancy on both graft and child. Data collected by the NTPR over the last 7 years have addressed these issues, thus providing additional information for health care providers of transplant recipients of childbearing age. There has been some refinement of prepregnancy guidelines, but there is a need for additional data collection so that organ-specific outcomes and risks can further be identified. To date, the outcomes of the children followed have been encouraging, and specific remote effects have not been identified, but continued surveillance is still vital. Of special concern are the new immunosuppressive drugs, specifically for mycophenolate mofetil (CellCept, Roche Laboratories Inc., Nutley, New Jersey), where data reported to the NTPR and through postmarketing surveillance have shown an increased incidence of nonviable outcomes and a specific pattern and increased incidence of malformation in the newborn, which has resulted in a pregnancy category change. Newer information points to an increased need for vigilance among centers and continued monitoring of pregnancy outcomes in this population. As the first reported pregnancy after transplantation occurred in a kidney recipient 50 years ago, in March 1958, this review also highlights the first reported pregnancies in other solid organ recipients.
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Affiliation(s)
- Vincent T Armenti
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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18
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Zarrinpar A, Farmer DG, Ghobrial RM, Lipshutz GS, Gu Y, Hiatt JR, Busuttil RW. Liver Transplantation for HELLP Syndrome. Am Surg 2007. [DOI: 10.1177/000313480707301020] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Of the approximately one in 1000 pregnant women who develop the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP), 2 to 3 per cent develop hepatic complications, including liver failure for which liver transplantation (LT) may be required. Between February 1, 1984, and December 31, 2006, eight women without a history of liver disease underwent LT for complications of HELLP syndrome. All received cadaveric grafts with a mean interval from delivery to LT of 7 days. The mean admission Child-Turcotte-Pugh score was 13.1 (class C), and the mean model for end-stage liver disease score was 40. Manifestations of liver failure included encephalopathy (seven patients), renal failure (four), disseminated intravascular coagulation (three), and respiratory failure (one). There were no intraoperative deaths. Complications of LT included biliary leaks (three patients), reoperation (three), and retransplantation (two). There was one death from sepsis on postoperative day 91 and one death from cholangitis/sepsis more than 5 years postoperatively. After LT, 1-, 5-, and 10-year patient survival rates were 88 per cent, 88 per cent, and 65 per cent; 1-, 5-, and 10-year graft survival rates were 64 per cent, 64 per cent, and 48 per cent. This is the largest single-center report of LT for HELLP. Early recognition and transfer to a transplant center will yield best results with this challenging complication of pregnancy.
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Affiliation(s)
- Ali Zarrinpar
- Dumont–UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Douglas G. Farmer
- Dumont–UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - R. Mark Ghobrial
- Dumont–UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gerald S. Lipshutz
- Dumont–UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Yan Gu
- Dumont–UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan R. Hiatt
- Dumont–UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ronald W. Busuttil
- Dumont–UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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