title: Hepatic failure in pregnancy successfully treated by online hemodiafiltration: Chronic hepatitis B virus infection without viral genome mutation.
abstract: A 23-year-old nulliparous woman, a hepatitis B virus (HBV) carrier with stable liver functions, presented with exacerbation of viral replication (HBV DNA level >9.0 log copies/mL) in gestational week 26. During the subsequent follow up without antiviral therapy, she was hospitalized with progression to hepatic failure in gestational week 35. Following initiation of antiviral therapy with lamivudine, emergent cesarean delivery was conducted for fetal safety. Liver atrophy and persistent hepatic encephalopathy (stage 2) necessitated artificial liver support (ALS) involving online hemodiafiltration (HDF) and plasma exchange. She regained full consciousness after the sixth online HDF session. ALS was terminated after the seventh online HDF session. On day 33 of hospitalization, she was discharged home without sequelae. Genetic analysis of the HBV strain isolated from her serum showed that this strain had genotype C. Direct full-length sequencing identified no known mutations associated with fulminant hepatitis B. HBV-related hepatic failure observed in the present case might have been related to perinatal changes in the host immune response.
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, Yokohama.
authors.forename: Shinju
authors.initials: S
authors.lastname: Arata
authors.forename: Akito
authors.initials: A
authors.lastname: Nozaki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takizawa
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kondo
authors.forename: Manabu
authors.initials: M
authors.lastname: Morimoto
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.forename: Sanae
authors.initials: S
authors.lastname: Hayashi
authors.forename: Tsunamasa
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
keywords: artificial liver support; blood purification therapy; flare; fulminant hepatitis; viral mutation