Prevention of Gestational Alloimmune Liver Disease by Intravenous Immunoglobulin Administration in the Second Trimester: A Presentation of Two Cases

Abstract

Gestational alloimmune liver disease (GALD) is identified as a member of the maternal-fetal alloimmune diseases. The target of alloantibodies in GALD is fetal liver where specific antigen is believed to be expressed mainly in developing hepatocytes. The attack of alloantibodies causes activation of fetal complement causing a developmental failure of liver parenchyma resulting in replacement of hepatocyte progenitors with mature hepatocytes. The progenitorinduced profibrogenic signals lead to extensive parenchymal fibrosis. 1 Moreover, main phenotypic manifestation of GALD seems to be neonatal liver disease associated with hemosiderosis of various extra-hepatic tissues which is defined as neonatal hemochromatosis (NH). 2 Consistent with the alloim-mune mechanism, GALD exhibits high recurrence rates up to 90% in pregnancies that can be prevented by antenatal intravenous immunoglobulin (IVIG) treatment. 1,[3][4][5] In the present study, we reported two cases with GALD recurrence that was prevented by antenatal IVIG treatment in the second trimester. CASE REPORTS CASE 1A 30-year-old woman, gravida 3 para 1 with a history of GALD, applied for prenatal consultation at 24 week of gestation (WG). The index case was uncomplicated until 37 WG. However; at this time, oligohydramnios and fetal growth restriction were