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