Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

Abstract

Background and Aims. Acute-on-chronic liver failure (ACLF) is common in patients with end-stage liver disease and chronic hepatitis B (CHB) or hepatitis B virus- (HBV-) related cirrhosis. To date, no uniform definition and management strategy are available for ACLF. Although a considerable number of studies on ACLF has been published, there are few reports on ACLF in pregnant women with CHB. This study retrospectively reviewed five patients who were diagnosed with ACLF during pregnancy in the past 10 years. We aimed at investigating their clinical characteristics, treatment, biochemical test results, and maternal and fetal outcomes. Results. Asthenia, anorexia, and jaundice were the main initial clinical manifestations in these patients during the second or third trimester of pregnancy. All patients received antiviral therapy. None of the pregnant women died after treatment. Patient #4 was treated with an artificial liver support system, and patients #2 and #5 underwent transfusion therapy. The acute insult in all patients was HBV DNA reactivation. Except for patient #3, who chose an actively induced vaginal delivery because of intrauterine fetal demise, the remaining four patients underwent a preterm delivery via a cesarean section. The four neonates were alive, although all were small for gestational age. Conclusion. Asthenia, anorexia, and jaundice during mid-late pregnancy should be immediately investigated. Before and during the pregnancy, hepatologists or obstetricians should actively screen pregnant women with CHB for HBV DNA status and alanine aminotransferase levels. Reactivation of HBV replication in pregnant women with CHB may lead to ACLF, especially in multiparous women. Once ACLF is diagnosed, antiviral therapy should be considered as soon as possible to protect maternal and fetal health.

Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy

“…Another study with 126 patients reported 25% chance of postpartum ALT flares which usually resolved spontaneously [184]. Acute-on-Chronic liver failure (ACLF) due to HBV reactivation had been reported in a case series of 5 patients (all were non-cirrhotic) and all recovered with antiviral treatment [185]. Rarely happened condition is patients requiring liver transplantation for fulminating hepatic failure due to HBV reactivation [140,186].…”

Effect of hepatitis B viral loads on gestational abnormal alanine aminotransferase modified by age

“…[9][10][11] Most hepatic ares are modest and resolve spontaneously, although extreme cases of liver failure have been disclosed. [12] Other studies have found that age-related hepatic histopathology can occur in individuals who are HBV DNA-negative and HBeAg-negative, [13] and young women are more likely to have excessive HBV DNA and HBeAg positivity. [14] Therefore, evidence has shown an association between maternal age and the presence of CHB.…”

Corrigendum to “Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study”

“…In the article titled “Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study” [ 1 ], the acknowledgements should read as follows:…”