Hepatic transplantation during pregnancy and the puerperium

Liver transplantation is the treatment of choice for many patients with acute and chronic hepatic failure. Although uncommon, hepatic failure may occur during pregnancy or after delivery, and liver transplantation may be life-saving. We report a case of a liver transplant performed during pregnancy in a patient with decompensated cirrhosis from chronic autoimmune hepatitis. A patient with chronic autoimmune hepatitis developed decompensated cirrhosis at approximately 18 weeks' gestation. Despite attempts at medical stabilization, her condition worsened, and an orthotopic liver transplant was performed at 23 weeks. The procedure was complicated by transient hypotension, and fetal death was diagnosed postoperatively. Her postoperative course was complicated by hypotension, infection, oliguric renal failure, anemia, thrombocytopenia, and rejection. She spontaneously labored on the 6th postoperative day and delivered without difficulty a 560-g stillborn male. The patient recovered and was discharged 31 days after surgery on prednisone, tacrolimus, mycostatin, erythropoietin, and iron. Liver transplantation may be a valuable therapeutic option for treatment of pregnant or puerperal women with hepatic failure.