Living donor liver transplantation for acute liver failure caused by acute fatty liver of pregnancy

Background: Acute fatty liver of pregnancy (AFLP) is a rare but serious maternal disease that occurs in the third trimester of pregnancy. Generally, prompt delivery can improve hepatic function, while delayed diagnosis and treatment of patients with AFLP could allow progression to acute liver failure. Case Report: A previously healthy 37-year-old woman presented to the clinic at 38 weeks gestation because of appetite loss and lower abdominal pain. Because her blood tests showed liver enzyme elevation, she was admitted to our hospital. She was diagnosed as having AFLP on the basis of clinical symptoms and laboratory data. She underwent an emergency caesarean section. Even after delivery, her condition worsened despite supportive care including plasma exchange and abdominal computed tomography (CT) showed atrophy of the liver. She underwent living donor liver transplantation on postpartum day 4. Histopathological findings were consistent with acute fatty liver of pregnancy. Conclusions: A small number of the patients with AFLP progress to fatal liver failure despite delivery of the fetus and aggressive supportive care. Liver transplantation is one treatment for acute liver failure caused by AFLP, and quantification of hepatic volume might be useful in prognostic prediction of the disease.