| Outcomes of severe pregnancy-related liver disease: refining the role of transplantation. | |
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MedLine Citation:
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PMID: 20977643 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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Severe liver disease in pregnancy is generally considered to have a favorable prognosis. The limited data available have not yielded disease-specific prognostic criteria or guidance on who should undergo liver transplantation (LT). We retrospectively evaluated 54 admissions with pregnancy-related liver disease to (1) evaluate if any admission parameters were associated with death and/or transplantation and (2) identify maternal complications. Eighteen had acute fatty liver of pregnancy and 32 had hypertension/eclampsia related disease. Seven patients (13%) died and four (7%) underwent LT. Survival rates were 43/48 if not listed for LT and 4/6 if listed. Of the four transplanted, three survived. Patients who died and/or underwent LT were more likely to have encephalopathy (p = 0.04) and hyperlactaemia (p = 0.03). Serum lactate was the best discriminant (ROC AUC 0.84). An admission lactate greater than 2.8mg/dL had 73% sensitivity and 75% specificity for predicting death or LT. The addition of encephalopathy to this parameter increased sensitivity and specificity to 90% and 86%, respectively. The King's College criteria were not effective in predicting outcome. This study confirms the overall favorable prognosis in pregnancy-related liver failure but indicates that elevated lactate levels in the presence of encephalopathy best identify patients at greatest risk of death or LT. |
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Authors:
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R H Westbrook; A D Yeoman; D Joshi; N D Heaton; A Quaglia; J G O'Grady; G Auzinger; W Bernal; M A Heneghan; J A Wendon |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons Volume: 10 ISSN: 1600-6143 ISO Abbreviation: Am. J. Transplant. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-27 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100968638 Medline TA: Am J Transplant Country: United States |
Other Details:
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Languages: eng Pagination: 2520-6 Citation Subset: IM |
Copyright Information:
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©2010 The Authors Journal compilation©2010 The American Society of Transplantation and the American Society of Transplant Surgeons. |
Affiliation:
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Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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