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Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy
Author(s) -
Martin James N.,
Briery Christian M.,
Rose Carl H.,
Owens Michelle T.,
Bofill James A.,
Files Joe C.
Publication year - 2008
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.20168
Subject(s) - medicine , acute fatty liver of pregnancy , liver transplantation , pregnancy , decompensation , liver disease , hellp syndrome , surgery , plasmapheresis , hepatic encephalopathy , gastroenterology , transplantation , fetus , cirrhosis , preeclampsia , immunology , genetics , antibody , biology
Acute fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic compromise that poses significant fetal‐maternal risk. Plasma exchange (PEX) is an effective bridge therapy to sustain liver function and enable hepatocellular regeneration to occur in nonpregnant patients following acute decompensation of a chronic liver disease or while awaiting liver transplantation. The application of PEX for patients with AFLP is a novel concept; since 1988 we have utilized postpartum PEX (PPEX) as adjunctive medical therapy for six patients with severe AFLP. Before PPEX initiation, four patients had signs and symptoms of encephalopathy, three required ventilatory support, five had advanced liver insufficiency, and all six were developing renal failure. PPEX was initiated 2–8 days following delivery and repeated (two to four times, mean = 3) at 24–48‐h intervals thereafter. All patients responded with composite clinical (symptoms/signs) and laboratory improvement; the average length of hospitalization following final PPEX for five of six patients was 7 days. No significant PPEX‐related complications occurred. PPEX utilization in patients with severe AFLP may enhance maternal recovery by preventing secondary sequelae from hepatic insufficiency until spontaneous healing can occur. Further study appears to be indicated to validate a role for PPEX as supportive therapy for puerperal patients with AFLP suffering multiorgan failure. J. Clin. Apheresis, 2008. © 2008 Wiley‐Liss, Inc.