%0 Journal Article
%T Acute Liver Failure Occurring during the First Trimester of Pregnancy Successfully Treated with Living Donor Liver Transplantation
%A Naoya Kanogawa
%A Tatsuo Kanda
%A Masayuki Ohtsuka
%A Masato Nakamura
%A Tatsuo Miyamura
%A Shin Yasui
%A Makoto Arai
%A Hitoshi Maruyama
%A Keiichi Fujiwara
%A Makio Shozu
%A Shigeto Oda
%A Masaru Miyazaki
%A Osamu Yokosuka
%J Case Reports in Transplantation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/309545
%X Acute liver failure (ALF) during pregnancy remains difficult to treat, and despite advances in treatment, liver transplantation must be selected as treatment option in certain cases. We report a 30-year-old woman with ALF of unknown etiology, occurring during the first trimester of pregnancy. Her condition was complicated by consciousness disturbance and coagulopathy due to ALF, but she was successfully treated with living donor liver transplantation 7 days after dilatation and curettage. At 9-month followup, she was in good medical condition. Liver transplantation has been reported as one of the treatment options for ALF during pregnancy with the prognosis varying depending on the trimester, from living donor or deceased donor liver transplantation. Of importance is that clinicians always think of emergent liver transplantation as a therapeutic option in ALF even in the first trimester of pregnancy. 1. Introduction Liver disease during pregnancy is classified into three categories as follows: (1) specific to pregnancy, (2) coincidental with pregnancy, and (3) preexisting liver disease [1, 2]. In the first trimester of a normal pregnancy, hyperemesis gravidarum occurs in 1¨C20 per 1000 pregnancies [3, 4]. On the other hand, fatty liver of pregnancy, preeclampsia or eclampsia, and HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome are three representative pregnancy-related diseases whose onset is usually between the 34th and the 36th weeks [1]. Treatment decisions for acute liver failure (ALF) are complicated by the diversity of its clinical presentations especially in pregnant women. Although liver transplantation supersedes empirical drug therapy in decompensated patients, pregnant patients warrant treatment modifications, and it is difficult to plan their therapies in certain cases because the lives of mother and baby should be rescued. Although there have been several reports about liver transplantation from deceased donors for ALF occurring during pregnancy [5¨C26], it is relatively rare in the first trimester of pregnancy [13, 15]. We experienced a case of acute liver failure, successfully treated with liver transplantation from a living related donor, which we report here. 2. Case Report A 30-year-old woman at week 12 of pregnancy was referred and transferred to Chiba University School of Medicine Hospital from another hospital with 10 days of liver test abnormalities and jaundice, for consciousness disturbance and coagulopathy. On the first admission into another hospital, two days after her first symptom of jaundice, her
%U http://www.hindawi.com/journals/crit/2013/309545/