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• W2041921031 abstract "The term HELLP syndrome indicates a group of eclamptic pregnant patients with hemolysis (H), elevated liver enzymes (EL), and low platelets (LP) (1). Susceptible women develop placental ischemia that in some unknown way triggers maternal endothelial cell dysfunction. Widespread vasoconstriction, plasma volume contraction, and intravascular coagulation lead to hypoperfusion of maternal organs and further impairment of placental blood flow. The fetus is particularly vulnerable, and the mother can die from severe complications, including liver hemorrhage and necrosis, acute renal failure, respiratory distress syndrome, and intracranial hemorrhage (2). The incidence of this potentially fatal complication is between 4% and 14% of all eclamptic pregnancies, with a mortality of 1% to 3% (1,3). We report the first successful liver transplantation with a graft from an eclamptic donor complicated by the HELLP syndrome. A 27-year-old previously healthy primigravida delivered a male baby. Immediately after delivery, a diagnosis of postpartum eclampsia associated with the HELLP syndrome was made because the blood pressure increased to 195/110 torr and edema appeared with proteinuria, convulsion, and altered mental state. Platelet counts of 51,000/mm3 and fibrinogen of 140 mg/dL were detected (Fig. 1, A). Serum glutamic-oxaloacetic transaminase (SGOT), Serum glutamic-pyruvic transaminase (SGPT), and total bilirubin concentrations were 878 U/L, 592 U/L, and 1.9 mg/dL, respectively (Fig. 1, B). A computed tomography scan of the head revealed an intracerebral hemorrhage leading to brain death. Figure 1: Platelet count and fibrinogen (A); serum activities of SGOT, SGPT, and total bilirubin concentration (B), beginning before delivery and continuing up until day 2 before harvest in a pregnant patient with HELLP syndrome and liver necrosis. Plt, platelets; TB, total bilirubin.On exploration the liver showed a normal color and consistency, and a biopsy revealed only minimal areas of periportal hepatocellular necrosis. The heart, liver, and kidneys were procured and transplanted. A 51-year-old male with hepatitis B virus cirrhosis at 2b United Network for Organ Sharing status received the transplant. The liver was well reperfused after 7 hr of cold ischemia time. The postoperative course was uneventful, and the patient was discharged on postoperative day 27 in good condition with prothrombin time 73%, total proteins 6.1 g/dL, albumin 3.6 mg/dL, SGOT 20 U/L, SGPT 49 U/L, and total bilirubin 1.8 mg/dL. He is alive and well with a 9-month follow-up. Until today, eclamptic pregnant patients also complicated by the HELLP syndrome were more likely considered as liver transplant recipients than donors (4). Indeed, their livers were not considered suitable for transplantation because of the rapid and progressive liver dysfunction during the period of donor evaluation associated with severe hemorrhagic hepatocellular necrosis in periportal regions. Recently, Woodside et al. (5) discarded a liver harvested from a donor with the HELLP syndrome because of the progression of hepatic necrosis (from minimal signs to 30%) during 6 hours of cold storage, which could have been exacerbated by hypothermia in University of Wisconsin solution as postulated by the author (5). Interestingly, we preserved the liver in Celsior for 7 hours, but with a single case it is hard to ascribe the absence of macroscopic changes of the liver to the preservation solution, even if the composition of Celsior is designed to further minimize ischemia-reperfusion injury, as compared to University of Wisconsin solution, by scavenging superoxide radicals and minimizing cell lysis. Livers procured from eclamptic donors, even if associated with the HELLP syndrome, could be suitable for transplantation if the favorable condition reported here is present. Bruno Nardo Roberto Montalti Paolo Beltempo Riccardo Bertelli Antonino Cavallari" @default.
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• W2041921031 date "2003-07-27" @default.
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• W2041921031 title "Successful liver transplantation from an eclamptic donor complicated by the Hellp syndrome" @default.
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• W2041921031 doi "https://doi.org/10.1097/01.tp.0000076628.39701.3e" @default.
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