Fulminant hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation

Samuel A. Ockner, Elizabeth M. Brunt, Steven Cohn, Elaine S. Krul, Douglas W. Hanto, Marion G. Peters

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

A previously healthy 35‐year‐old woman was seen at 37 weeks' gestation with a 10‐day history of fever, vomiting, diarrhea and malaise. Serum laboratory findings included elevation of serum bilirubin and AST, prolongation of serum prothrombin time and a positive monospot. A tentative diagnosis of acute fatty liver of pregnancy was made, and a healthy male infant was delivered by emergency cesarean section because of fetal distress. Over the subsequent 3 days, acute progressive oliguric renal failure, disseminated intravascular coagulation, hypoglycemia requiring intravenous dextrose infusion and pancreatitis developed; her mental status progressed to stage III encephalopathy. Quantitative computed tomography estimated the liver volume to be 770 cm3. The decision to proceed with orthotopic liver transplantation was made on the basis of progressive clinical deterioration despite aggressive support and because of her small liver size. After transplant, the patient's multisystem failure rapidly reversed. Histopathological examination of the native liver demonstrated predominantly zone 3 microvesicular steatosis with characteristic ultrastructural changes consistent with acute fatty liver of pregnancy. Southern blot analysis for Epstein‐Barr virus DNA was negative. We conclude that orthotopic liver transplantation should be considered for the small group of patients with fulminant hepatic failure associated with acute fatty liver of pregnancy who manifest signs of irreversible liver failure despite delivery of the fetus and aggresive supportive care.

Original languageEnglish (US)
Pages (from-to)59-64
Number of pages6
JournalHepatology
Volume11
Issue number1
DOIs
StatePublished - Jan 1 1990
Externally publishedYes

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Acute Liver Failure
Liver Transplantation
Liver
Serum
Fetal Distress
DNA Viruses
Disseminated Intravascular Coagulation
Prothrombin Time
Liver Failure
Brain Diseases
Southern Blotting
Bilirubin
Hypoglycemia
Intravenous Infusions
Cesarean Section
Pancreatitis
Vomiting
Renal Insufficiency
Diarrhea
Fetus

ASJC Scopus subject areas

  • Hepatology

Cite this

Fulminant hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation. / Ockner, Samuel A.; Brunt, Elizabeth M.; Cohn, Steven; Krul, Elaine S.; Hanto, Douglas W.; Peters, Marion G.

In: Hepatology, Vol. 11, No. 1, 01.01.1990, p. 59-64.

Research output: Contribution to journalArticle

Ockner, Samuel A. ; Brunt, Elizabeth M. ; Cohn, Steven ; Krul, Elaine S. ; Hanto, Douglas W. ; Peters, Marion G. / Fulminant hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation. In: Hepatology. 1990 ; Vol. 11, No. 1. pp. 59-64.
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