Icahn School of Medicine at Mount Sinai, New York, New York.
Jefferson University Hospital, Philadelphia, Pennsylvania.
Am J Transplant. 2019 Jul;19(7):2101-2107. doi: 10.1111/ajt.15401. Epub 2019 May 16.
Acute fatty liver of pregnancy (AFLP) often resolves after pregnancy delivery but can progress to acute liver failure necessitating liver transplantation. We performed a retrospective review of the national Scientific Registry of Transplant Recipients (SRTR) data to identify all women in the United States undergoing liver transplantation (LT) for acute liver failure (ALF) from AFLP from 1991 to 2015, and compared to outcomes in women of childbearing age undergoing transplant for ALF from acetaminophen and ALF from other etiologies. Women with AFLP were likely to be on life support at time of LT and had high rates of renal dysfunction (median Cr 2.1, IQR 1.2-2.3), and hyperbilirubinemia (median bilirubin 17.1, IQR 11.0, 19.9). Although their early and late LT survival outcomes were comparable to the other indications for LT, cumulative 5-year graft survival was numerically lower among AFLP patients (54%, 95% CI, 27-76) compared to APAP (70%, 95% CI, 63-77) and "Other ALF" (76%, 95% CI, 72-80) groups. In conclusion, although AFLP is a rare indication for LT, AFLP patients were as sick or sicker than other women of childbearing age undergoing LT for ALF. Worsened graft survival may be related to higher rates of rejection in the AFLP group.
妊娠急性脂肪肝（AFLP）常在分娩后自行缓解，但也可能进展为急性肝功能衰竭，需要进行肝移植。我们对美国国家器官获取与移植网络（SRTR）的数据进行了回顾性分析，以确定 1991 年至 2015 年间所有因 AFLP 导致急性肝功能衰竭而接受肝移植（LT）的美国女性，并与因乙酰氨基酚和其他病因导致急性肝功能衰竭而接受移植的育龄女性的结局进行比较。AFLP 患者在 LT 时更可能需要生命支持，且肾功能障碍（中位数 Cr2.1，IQR1.2-2.3）和高胆红素血症（中位数胆红素 17.1，IQR11.0，19.9）的发生率较高。尽管 AFLP 患者的早期和晚期 LT 生存率与其他 LT 适应证相当，但与因乙酰氨基酚（70%，95%CI，63-77）和“其他 ALF”（76%，95%CI，72-80）患者相比，AFLP 患者的 5 年累积移植物存活率在数值上较低（54%，95%CI，27-76）。总之，尽管 AFLP 是 LT 的罕见适应证，但 AFLP 患者与因 ALF 接受 LT 的其他育龄女性一样病重或更病重。移植物存活率下降可能与 AFLP 组排斥反应发生率较高有关。
