Liver transplantation for acute liver failure due to hepatitis E in a pregnant patient

Babu, Rakesh; Kanianchalil, Kishore; Sahadevan, Sajeesh; Nambiar, Rajesh; Kumar, Anish

doi:10.4103/ija.ija_149_18

Cited by 4 publications

(9 citation statements)

References 4 publications

(4 reference statements)

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“…The literature regarding the care of these patients is very limited, and few clear standards or best practices can be derived from what is currently published. We found 27 case reports, 10‐36 representing the experience of 22 patients, largely supporting this surgery as safe for mothers, but variably safe for fetuses. Below, we present some general principles for the care of these patients that take into account the findings of this systematic review.…”

Section: Discussionmentioning

confidence: 79%

“…Discussion of postoperative management in the reported cases was scarce; however, the postoperative disposition was specified in 7 cases as the intensive care unit with one case 29 specifically reporting a transplant intensive care unit. Six of the 22 cases required reoperation, with 2 requiring retransplantation for graft failure within the first 2‐3 postoperative days (ABO compatibility/graft ischemia), 2 for bleeding complications and 2 for biliary stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Discussion of postoperative management in the reported cases was scarce; however, the postoperative disposition was specified in 7 cases as the intensive care unit with one case 29 In cases of combined cesarean/OLT, NICU care of the neonate combined with ICU care of the mother may delay typical mother-infant bonding through "skin-to-skin" or nursing, although this will be dependent on the speed of maternal recovery.…”

Section: Postoperative Managementmentioning

confidence: 99%

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Orthotopic liver transplant in the pregnant recipient: A systematic review of preoperative management and maternal and fetal outcomes

Romano

Mokuolu

Katz

et al. 2021

Clinical Transplantation

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Liver transplantation is an effective, often curative treatment for end-stage liver disease, acute liver failure, and primary hepatic malignancy. [1][2][3][4] Since 2012, the number of liver transplants performed annually has increased, with 8,896 performed nationally in 2019. 5 Women constitute 37% of patients who have had liver transplantation, with about 12% being of reproductive age (18-49 years old).Another 5% are pediatric female liver transplant recipients, who have > 80% survival into adulthood and thus may likely consider pregnancy. 5,6 Since the first pregnancy in a liver transplant recipient in 1978, outcomes for both mother and fetus have greatly improved. Recent studies report a 20-year maternal survival rate of 53% and a live birth rate of 75% 7,8 in patients who became pregnant after liver transplantation. With advancements in transplant immunosuppression, organ preservation, and donor and recipient transplantation surgical techniques, female liver transplant recipients are generally able to plan a safe pregnancy by 1-2 years after transplant. 9While there is robust literature about patients having successful pregnancies after liver transplant, few studies discuss liver transplantation during pregnancy. To our knowledge, there has been no consensus on the expected outcomes of these patients and their fetuses, nor a discussion of the optimal perioperative management of pregnant patients undergoing liver transplant. The purpose of this study was to perform a systematic review of the literature analyzing the clinical outcomes of these patients and their fetuses, the etiologies leading to liver transplant during pregnancy, and the anesthetic management of liver transplantation during pregnancy.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

“…Discussion of postoperative management in the reported cases was scarce; however, the postoperative disposition was specified in 7 cases as the intensive care unit with one case 29 In cases of combined cesarean/OLT, NICU care of the neonate combined with ICU care of the mother may delay typical mother-infant bonding through "skin-to-skin" or nursing, although this will be dependent on the speed of maternal recovery.…”

Section: Postoperative Managementmentioning

confidence: 99%

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Orthotopic liver transplant in the pregnant recipient: A systematic review of preoperative management and maternal and fetal outcomes

Romano

Mokuolu

Katz

et al. 2021

Clinical Transplantation

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“…HEV-gt1 infection in pregnant women causes several alterations in innate and adaptive immune response, which help virus replication and increase the severity of disease in the mother [134]. Pregnant women with HEV-ALF have impaired macrophage phagocytic activity and downregulation of TLR3 & TLR9 expression impeding MyD88-mediated IFN production [135,136].…”

Section: Immune Response In Hev Infected Pregnant Womenmentioning

confidence: 99%

“…Management policies to treat complications of ALF namely encephalopathy, cerebral edema, hypoglycaemia, coagulopathy, and possible DIC, GI bleed, sepsis, and renal failure have been well standardized and should be immediately enforced. Liver transplantation team if available must be involved and considered if prognostic criteria employed are met[103,104,131,132].Unfortunately, as of today, only isolated case reports of liver transplantation in pregnant women with HEV-ALF are published in the literature[133][134][135] A close obstetric watch is needed in both HEV-AVH and HEV-ALF patients to evaluate the stage of pregnancy, fetal wellbeing, and growth. Complications like abortions, preterm labour, premature rupture of membranes, stillbirth, intrauterine deaths, and increased risk of bleeding associated with coagulopathy can occur and need to be aggressively managed by standard obstetric guidelines…”

mentioning

confidence: 99%

Hepatitis E and Pregnancy: An Unholy Alliance

Khuroo¹

2021

Preprint

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The adverse relationship between viral hepatitis and pregnancy in developing countries was seen as a reflection of retrospective biased hospital-based data collection by the West. However, the discovery of HEV from an epidemic of non-A, non-B hepatitis in Kashmir and documenting increased incidence and severity of hepatitis E in pregnancy from a house-to-house survey unmasked the unholy alliance. Among the family of HEV’s, genotype (gt)-1, with a unique ORF4-encoded protein enhancing viral polymerase activity and viral replication, is the sole HEV that shows this adverse relationship. The epidemics caused by HEV-gt1 and not by HEV-gt2 show adverse relationship with pregnancy. The pathogenesis of the unholy alliance is complex and at present not well understood. Possibly multiple factors play a role in causing severe liver disease in the mother including: infection, replication and damage to the maternal-foetal interface by HEV-gt1; vertical transmission of HEV to foetus causing severe foetal/neonatal hepatitis; and combined viral and hormone related immune dysfunction of diverse nature in the mother promoting viral replication. Management is multidisciplinary and needs a close watch for the development and management of ALF. Preliminary data suggest beneficial maternal outcomes by early termination of pregnancy in patients with lower grades of encephalopathy.

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The Spectrum of Hepatic Critical Care During Pregnancy: A Clinical Review

Matos

Reau

2022

Clinical Obstetrics &Amp; Gynecology

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Hepatic disease during pregnancy can result in the development of critical illness requiring special attention from a multidisciplinary team with a low threshold for tertiary care transfer to provide access to liver transplantation. Management of this population requires taking into consideration the benefit and risks of both mother and fetus. A myriad of diseases has been recognized, some being unique to pregnancy while others are common to the general population. We present a review of the literature on the diagnosis, management, and prognosis of these diseases to aid in the optimization of care in this special population.

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Liver transplantation for acute liver failure due to hepatitis E in a pregnant patient

Cited by 4 publications

References 4 publications

Orthotopic liver transplant in the pregnant recipient: A systematic review of preoperative management and maternal and fetal outcomes

Orthotopic liver transplant in the pregnant recipient: A systematic review of preoperative management and maternal and fetal outcomes

Hepatitis E and Pregnancy: An Unholy Alliance

The Spectrum of Hepatic Critical Care During Pregnancy: A Clinical Review

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