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. 2023 Jan 1;107(1):172-180.
doi: 10.1097/TP.0000000000004290. Epub 2022 Aug 31.

Urgent Liver Transplantation for Acute Liver Failure in Pregnant Women: The Optimum Timing for Delivery

Philippe Ichai  1   2   3 , Hanane Bouchghoul  4 , Astrid Laurent-Bellue  5 , Sophie-Caroline Sacleux  1   3 , Marc Boudon  1   2   3 , Daniel Cherqui  2   3   6 , Pauline Tortajada  6 , Marius Braun  7 , Elise Lemaitre  1 , Gabriella Pittau  2   3   6 , Marie-Amélie Ordan  1   3 , Sharon Levi  1 , Daniel Azoulay  2   3   6 , Herve Fernandez  4 , Catherine Guettier  2   3   5 , Didier Samuel  1   2   3 , Faouzi Saliba  1   2   3
Affiliations

Urgent Liver Transplantation for Acute Liver Failure in Pregnant Women: The Optimum Timing for Delivery

Philippe Ichai et al. Transplantation. .

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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Conflict of interest statement

The authors declare no funding or conflicts of interest.

References

    1. Ichai P, Samuel D. Etiology and prognosis of fulminant hepatitis in adults. Liver Transpl. 2008;14:S67–S79.
    1. Naoum EE, Leffert LR, Chitilian HV, et al. Acute fatty liver of pregnancy: pathophysiology, anesthetic implications, and obstetrical management. Anesthesiology. 2019;130:446–461.
    1. Fesenmeier MF, Coppage KH, Lambers DS, et al. Acute fatty liver of pregnancy in 3 tertiary care centers. Am J Obstet Gynecol. 2005;192:1416–1419.
    1. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103:981–991.
    1. Aloizos S, Seretis C, Liakos N, et al. HELLP syndrome: understanding and management of a pregnancy-specific disease. J Obstet Gynaecol. 2013;33:331–337.

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