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.
Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom.
R H
RH
Westbrook
A D
AD
Yeoman
D
D
Joshi
N D
ND
Heaton
A
A
Quaglia
J G
JG
O'Grady
G
G
Auzinger
W
W
Bernal
M A
MA
Heneghan
J A
JA
Wendon
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