Successful orthotopic liver transplantation and delayed delivery of a healthy newborn in a woman with fulminant hepatic failure during the second trimester of pregnancy

Mendizábal, Manuel; Rowe, Carlos; Piñero, Federico; González-Campaña, Ariel; Fauda, Martín; Arufe, Diego; Raffa, Maria Pia; Barreiro, Mariano; Keller, Rodolfo; Cacheiro, Fernando; Beruti, Ernesto; Andriani, Oscar; Silva, Marcelo Oscar; Podestá, Luis G.

doi:10.1016/s1665-2681(19)30893-2

Cited by 6 publications

(6 citation statements)

References 15 publications

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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%

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%

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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“…202 Similar cases have been reported elsewhere with successful maternal and fetal outcomes. 203,204 A retrospective data from King's College Hospital studied 54 patients with pregnancy-induced liver disease: 44 patients survived with medical management, 6 died without transplantation, and 4 underwent LT. Patients who underwent LT and/or died had a higher incidence of HE (p = 0.04) and high lactate (p = 0.03).…”

Section: Transplantation In a Pregnant Ladymentioning

confidence: 99%

Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure

Anand

Nandi²,

Acharya

et al. 2020

Journal of Clinical and Experimental Hepatology

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Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by antituberculosis drug-induced hepatotoxicity are the commonest causes of ALF in India. Clinically, such patients present with appearance of jaundice, encephalopathy, and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF, followed by superadded infections, and determine the outcome in these patients. The pathogenesis of

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“…In the literature, 2 of the 9 patients, both pregnant at 27 WG at admission, gave birth before LT to a living infant. The 7 other patients, with a median gestational age of 25 WG [ at admission, gave birth after LT at a median of 36 WG [IQR [28][29][30][31][32][33][34][35][36][37] to a living infant. Two fetuses died at 24 and 26 MG, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…One infant survived in each group. Among the 32 cases published previously, 11 (34%) had been transplanted after delivery (median GA:31 [28][29][30][31][32][33]); 10 of these 11 infants were alive at birth. The other 21 mothers were transplanted before delivery (GA:21 WG [18][19][20][21][22]).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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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Successful orthotopic liver transplantation and delayed delivery of a healthy newborn in a woman with fulminant hepatic failure during the second trimester of pregnancy

Cited by 6 publications

References 15 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

Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure

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

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