Outcomes of severe pregnancy-related liver disease: refining the role of transplantation.
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.
Westbrook
R H
RH
Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom.
Yeoman
A D
AD
Joshi
D
D
Heaton
N D
ND
Quaglia
A
A
O'Grady
J G
JG
Auzinger
G
G
Bernal
W
W
Heneghan
M A
MA
Wendon
J A
JA
D000328:Adult; D005234:Fatty Liver / Q000150:complications; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000601:surgery; D019344:Lactic Acid / Q000097:blood; D008107:Liver Diseases / Q000209:etiology / Q000601:surgery; D017114:Liver Failure, Acute / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D019344:Lactic Acid