Anesth Pain Med.  2019 Apr;14(2):197-201. 10.17085/apm.2019.14.2.197.

Hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation: A case report

• Bang YS
• Ko D
• Lee S
• Lee S
• Park C

• KMID: 2447969
• DOI: http://doi.org/10.17085/apm.2019.14.2.197

Abstract

Acute fatty liver of pregnancy (AFLP) is unusual but can potentially progress to overwhelming liver failure, resulting in maternal and fetal death. AFLP is characterized by the accumulation of microvesicular fat within hepatocytes. We report the case of a 37-year-old woman at 36 weeks' gestation with a twin pregnancy who was admitted with the diagnosis of intrauterine fetal death of one baby. The patient showed profile of AFLP on her laboratory findings and underwent emergency cesarean section. Then she progressed to cryptogenic fulminant hepatic failure and underwent successful orthotopic liver transplantation on 9th day of admission. This case demonstrates that liver transplantation is a feasible therapeutic option for the treatment of patients with this condition.

Keyword

Acute liver failure; Cesarean section; Fatty liver; General anesthesia; Liver transplantation

MeSH Terms

Adult
Anesthesia, General
Cesarean Section
Diagnosis
Emergencies
Fatty Liver*
Female
Fetal Death
Hepatocytes
Humans
Liver Failure*
Liver Failure, Acute
Liver Transplantation*
Liver*
Pregnancy*
Pregnancy, Twin

Reference

1. Remiszewski P, Pawlak J, Skwarek A, Grzelak I, Patkowski W, Grodzicki M, et al. Orthotopic liver transplantation for acute liver failure resulting from “acute fatty liver of pregnancy”. Ann Transplant. 2003; 8:8–11. PMID: 15114933.

2. Knox TA, Olans LB. Liver disease in pregnancy. N Engl J Med. 1996; 335:569–76. DOI: 10.1056/NEJM199608223350807. PMID: 8678935.

3. Stander HJ, Cadden JF. Acute yellow atrophy of the liver in pregnancy. Am J Obstet Gynecol. 1934; 28:61–9.

4. Pockros PJ, Peters RL, Reynolds TB. Idiopathic fatty liver of pregnancy: findings in ten cases. Medicine (Baltimore). 1984; 63:1–11. DOI: 10.1097/00005792-198401000-00001.

5. Treem WR, Shoup ME, Hale DE, Bennett MJ, Rinaldo P, Millington DS, et al. Acute fatty liver of pregnancy, hemolysis, elevated liver enzymes, and low platelets syndrome, and long chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency. Am J Gastroenterol. 1996; 91:2293–300. PMID: 8931405.

6. Riely CA. Acute fatty liver of pregnancy. Semin Liver Dis. 1987; 7:47–54. DOI: 10.1055/s-2008-1040563. PMID: 3296215.

7. Ahmed KT, Almashhrawi AA, Rahman RN, Hammoud GM, Ibdah JA. Liver diseases in pregnancy: diseases unique to pregnancy. World J Gastroenterol. 2013; 19:7639–46. DOI: 10.3748/wjg.v19.i43.7639. PMID: 24282353. PMCID: PMC3837262.

8. Riely CA, Latham PS, Romero R, Duffy TP. Acute fatty liver of pregnancy. A reassessment based on observations in nine patients. Ann Intern Med. 1987; 106:703–6. DOI: 10.7326/0003-4819-106-5-703. PMID: 3565968.

9. Brown MA, Passaris G, Carlton MA. Pregnancy-induced hypertension and acute fatty liver of pregnancy: atypical presentations. Am J Obstet Gynecol. 1990; 163:1154–6. DOI: 10.1016/0002-9378(90)90677-Y.

10. Gregory TL, Hughes S, Coleman MA, De Silva A. Acute fatty liver of pregnancy;three cases and discussion of analgesia and anaesthesia. Int J Obstet Anesth. 2007; 16:175–9. DOI: 10.1016/j.ijoa.2006.10.004. PMID: 17275281.

11. Holzman RS, Riley LE, Aron E, Fetherston J. Perioperative care of a patient with acute fatty liver of pregnancy. Anesth Analg. 2001; 92:1268–70. DOI: 10.1097/00000539-200105000-00036. PMID: 11323360.

12. Rahman TM, Wendon J. Severe hepatic dysfunction in pregnancy. QJM. 2002; 95:343–57. DOI: 10.1093/qjmed/95.6.343. PMID: 12037242.

13. Ockner SA, Brunt EM, Cohn SM, Krul ES, Hanto DW, Peters MG. Fulminant hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation. Hepatology. 1990; 11:59–64. DOI: 10.1002/hep.1840110112. PMID: 2403963.

14. Castro MA, Fassett MJ, Reynolds TB, Shaw KJ, Goodwin TM. Reversible peripartum liver failure: a new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J Obstet Gynecol. 1999; 181:389–95. DOI: 10.1016/S0002-9378(99)70567-3.

15. Doepel M, Backas HN, Taskinen EI, Isoniemi HM, Höckerstedt KA. Spontaneous recovery of post partus liver necrosis in a patient listed for transplantation. Hepatogastroenterology. 1996; 43:1084–7. PMID: 8884344.