title: Successful orthotopic liver transplantation and delayed delivery of a healthy newborn in a woman with fulminant hepatic failure during the second trimester of pregnancy.
abstract: Severe liver dysfunction during pregnancy implies a serious risk for both mother and fetus, and represents a technical and ethical challenge for treating physicians. We report a case of a previously healthy 32-year old woman who was admitted to our hospital with idiopathic fulminant hepatic failure and underwent successful orthotopic liver transplantation (OLT) at gestation week 21. Patient's and fetus' immediate postoperative course were relatively uneventful until week six after OLT, when the mother developed oligohydramnios and preeclampsia. At pregnancy week 27, after inducing baby's lung maturation, a cesarean section was performed with the delivery of an otherwise healthy girl. After 3 years of follow-up, mother and child are leading normal lives with no complications related either to pregnancy or to OLT. We describe the case of a successful emergency liver transplant in a woman during the second trimester of pregnancy, demonstrating that OLT can be a viable option to preserve the life of the mother and an otherwise unviable fetus. Intrauterine baby's growths until the attainment of a viable gestational age was feasible despite the mother's fulminant hepatic failure and liver transplant surgery.
authors.affiliation: Hepatology and Liver Transplant Unit, Argentina.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendizabal
authors.affiliation: Department of Transplant Surgery, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rowe
authors.affiliation: Hepatology and Liver Transplant Unit, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Piñero
authors.affiliation: Department of Transplant Surgery, Argentina.
authors.forename: Ariel
authors.initials: A
authors.lastname: Gonzalez-Campaña
authors.affiliation: Department of Transplant Surgery, Argentina.
authors.forename: Martín
authors.initials: M
authors.lastname: Fauda
authors.affiliation: Hepatology and Liver Transplant Unit, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Tomás Arufe
authors.affiliation: Hepatology and Liver Transplant Unit, Argentina.
authors.forename: María
authors.initials: M
authors.lastname: Pía Raffa
authors.affiliation: Department of Transplant Surgery, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Barreiro
authors.affiliation: Neonatal Intensive Care Unit, Argentina.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Keller
authors.affiliation: Department of Anesthesiology, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cacheiro
authors.affiliation: Maternal and Child Department, Argentina.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Beruti
authors.affiliation: Department of Transplant Surgery, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Andriani
authors.affiliation: Hepatology and Liver Transplant Unit, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Oscar Silva
authors.affiliation: Department of Transplant Surgery, Argentina.
authors.forename: Luis Gustavo
authors.initials: LG
authors.lastname: Podestá
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome