A successful use of therapeutic plasma exchange in a fulminant form of acute fatty liver of pregnancy

Rebahi, Houssam; Still, Megan; Adib, Ahmed Rhassane El

doi:10.1016/j.jogoh.2018.10.001

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…There have been few reported cases of AFLP recurring in women with a previous pregnancy complicated by AFLP. Similar to preeclampsia and HELLP syndrome delivery is the best option to halt further organ injury, however some patients have received blood product transfusion to help improve anemia and coagulation (76)(77)(78).…”

Section: Acute Fatty Liver Of Pregnancymentioning

confidence: 99%

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

et al. 2020

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Acute kidney injury that occurs during pregnancy or in the post-partum period (PR-AKI) is a serious obstetric complication with risk of significant associated maternal and fetal morbidity and mortality. Recent data indicates that the incidence of PR-AKI is increasing, although accurate calculation is limited by the lack of a uniform diagnostic criteria that is validated in pregnancy. Hypertensive and thrombotic microangiopathic disorders of pregnancy have been identified as major contributors to the burden of PR-AKI. As is now accepted regarding preeclampsia, HELLP syndrome and atypical hemolytic uremic syndrome, it is believed that PR-AKI may have long-term renal, cardiovascular and neurocognitive consequences that persist beyond the post-partum period. Further research regarding PR-AKI could be advanced by the development of a pregnancy-specific validated definition and classification system; and the establishment of refined animal models that would allow researchers to further elucidate the mechanisms and sequelae of the disorder.

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Section: Acute Fatty Liver Of Pregnancymentioning

confidence: 99%

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

et al. 2020

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“…Plasma exchange can also reduce the levels of membrane receptor B7 in sera from patients with ALF 23 . The clinical benefit of HVPE for patients with ALF has also been shown in case reports, 24‐26 and a randomized controlled trial 13 …”

Section: Discussionmentioning

confidence: 91%

Initial experience with high‐volume plasma exchange in patients with acute liver failure

Kim

Chun

Sinn

et al. 2021

J of Clinical Apheresis

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Background/Aims High‐volume plasma exchange (HVPE), defined as an exchange of 8 to 12 L per day per procedure or 15% of the ideal body weight with fresh frozen plasma, has shown promising results in improving the survival of patients with acute liver failure (ALF). However, clinical evidence is limited. The aim of this study was to report our initial experience using HVPE as a bridge treatment in patients with ALF. Methods We retrospectively reviewed 32 consecutive patients awaiting liver transplantation (LT) due to ALF between 2013 and 2020 at Samsung Medical Center in Korea. HVPE has been used for patients with ALF since May 2016 at our institution. Results During the study period, 16 patients received HVPE. After HVPE, coagulopathies (INR, 4.46 [2.32‐6.02] vs 1.48 [1.33‐1.76], P < .05), total bilirubin (22.6 [9.1‐26.4] vs 8.9 [5.6‐11.3], P < .05), alanine aminotransferase (506 [341‐1963] vs 120 [88‐315], P < .05), and ammonia levels (130.6 [123.7‐143.8] vs 98.2 [84.2‐116.5], P < .05) were improved. Improvement in the hepatic encephalopathy grade was observed in four patients. Among 16 patients who received HVPE, 12 patients were bridged to LT, and three patients recovered spontaneously. The overall survival was 94% and 69%, respectively at 30 days in patients who received and did not receive HVPE (P = .068). Among 18 patients with high chronic liver failure‐sequential organ failure assessment scores (≥13), the overall survival was significantly better for those who received HVPE than for those who did not (91% vs 29%, respectively, at 30 days, P < .05). Conclusions Our initial clinical experience with HVPE suggests that HVPE can be a viable option in improving the outcomes of patients presenting with ALF.

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“…Intensive care monitoring should be extended to 10–14 days postpartum in patients who do not show recovery in anticipation of the appearance of new complications. Some of these cases needed liver transplantation, 48 whereas others responded successfully to plasma exchange therapy especially when instituted early 49 . It is advisable before delivery to assess the severity of coagulopathy, to allow planning to restore fibrinogen and other procoagulants to clinically functional levels with fresh frozen plasma, cryoprecipitate or whole blood if operative delivery is anticipated.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the integration of antithrombin III, high sFlt‐1, high sFlt‐1/PlGF ratio and hypocholesterolemia/triglyceridemia in the work‐up might permit earlier diagnosis particularly when discerning between AFLP and PET/HELLP syndrome. Stabilizing the patient before expedited delivery, close intensive monitoring by a multidisciplinary team at intensive care units together with early institution of “plasma exchange therapy” 49 or “artificial liver support therapy” 51 in the management of complicated postpartum cases might further improve survival rate.…”

Section: Discussionmentioning

confidence: 99%

Second‐trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report

Ramadan

Khazaal

Cha'ar

et al. 2020

J of Obstet and Gynaecol

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Acute fatty liver disease of pregnancy (AFLP) is a rare life‐threatening medical emergency unique to pregnancy. It is characterized by progressive microvesicular fatty infiltration of maternal hepatocytes, but the exact etiology has yet to be elucidated. AFLP typically manifests in late third trimester or immediately postpartum and seldom during second trimester. Prompt delivery, irrespective of gestational age or severity, is crucial for arresting the insult and permitting recovery. We hereby report a 21‐year‐old Lebanese second‐gravid woman at 20 weeks' gestation diagnosed with AFLP depending on clinical features and compatible laboratory studies (score of 8 on Swansea criteria), in spite of early occurrence. A review and analysis of early AFLP (second trimester) compared to late (third trimester) was also presented. AFLP appearing during second trimester is as serious as the disease manifesting in late third trimester, with similar diagnostic difficulties, less association with hypertension, but with greater hesitation of obstetricians to affect prompt delivery and higher adverse perinatal outcome due to added effect of premature delivery in second trimester.

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A successful use of therapeutic plasma exchange in a fulminant form of acute fatty liver of pregnancy

Cited by 10 publications

References 28 publications

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

Initial experience with high‐volume plasma exchange in patients with acute liver failure

Second‐trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report

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