A case Report : Successful MARS therapy for acute liver failure in pregnancy

Acute liver failure (ALF) in pregnancy is a rare life-threatening condition most frequently appearing in the third trimester of pregnancy or the early postpartum period. ALF specific to pregnancy including pre-eclampsia, associated with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, acute fatty liver of pregnancy, and hepatic infarction result in increased maternal and fetal mortality if not recognized and acted on early. Treatment of acute fatty liver of pregnancy is a combination of maternal stabilization and prompt delivery of the fetus, regardless of gestational age. In severe cases, mostly when diagnosis has been delayed, there may be many more days of illness requiring maximal supportive management in an intensive care unit, including mechanical ventilation because of coma, dialysis for acute renal failure, parenteral nutrition because of associated pancreatitis, or even surgery to treat bleeding from a preceding cesarean section. The molecular adsorbents recirculating system (MARS) is the best known blood detoxification system based on albumin dialysis indicated for patients with acute liver failure and acute on chronic liver failure. MARS is usually used for the treatment of drug overdoses, poisoning and hepatic encephalopathy and has also been studied in acute liver failure. Herein, we report an interesting case of 28-year-old female patient(Pregnancy 36wks + 1) that pregnancy induced acute liver failure, DIC, and AKI was improved by best supportive care after MARS.