Document Detail


Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy.
MedLine Citation:
PMID:  18633996     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
James N Martin; Christian M Briery; Carl H Rose; Michelle T Owens; James A Bofill; Joe C Files
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical apheresis     Volume:  23     ISSN:  1098-1101     ISO Abbreviation:  J Clin Apher     Publication Date:  2008  
Date Detail:
Created Date:  2008-08-11     Completed Date:  2008-12-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8216305     Medline TA:  J Clin Apher     Country:  United States    
Other Details:
Languages:  eng     Pagination:  138-43     Citation Subset:  IM    
Affiliation:
Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA. jnmartin@ob-gyn.umsmed.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Fatty Liver / diagnosis,  pathology,  therapy*
Female
Humans
Plasma Exchange*
Postpartum Period*
Pregnancy
Pregnancy Complications / diagnosis,  pathology,  therapy*
Recovery of Function
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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