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Published on: May 29, 2020
Gestational Alloimmune Liver Disease
Katie R Conover1, Sarah A Taylor1
1Department of Pediatrics, Pediatric Liver Center, Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
Abstract:
Gestational alloimmune liver disease (GALD) is a top cause of neonatal acute liver failure that is highly preventable in subsequent pregnancies after the index case. The understood mechanism involves placental passage of maternal antibodies targeting an unknown fetal hepatocyte antigen, leading to complement activation and extensive hepatocyte damage and fibrosis. This disease mechanism explains the clinical presentation of liver failure shortly after birth. Intravenous immunoglobulin and double volume exchange transfusion can improve neonatal outcomes, likely due to dampening the effect of circulating maternal antibodies. Early recognition of GALD depends on a high index of clinical suspicion.
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