Beating the Odds: A Full-Term Delivery After Liver Transplantation of a Pregnant Hyperthyroid Patient at 19 Weeks' Gestation for Propylthiouracil-Induced Acute Liver Failure

• Published in: Transplantation proceedings 2018-12, Vol.50 (10), p.3995-3999
• Main Authors: Bartnik, C.M., Maheshwari, R.N., Subramanian, R.M.
• Format: Article
• Language: English
• Subjects: Adult; Antithyroid Agents - adverse effects; Female; Graves Disease - complications; Graves Disease - drug therapy; Humans; Live Birth; Liver Failure, Acute - chemically induced; Liver Failure, Acute - surgery; Liver Transplantation - methods; Pregnancy; Pregnancy Complications - chemically induced; Pregnancy Complications - surgery; Propylthiouracil - adverse effects
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.06.046

Liver transplantation (LT) for acute liver failure is an uncommon occurrence in the setting of pregnancy given the risk of fetal demise, and rarely is it undertaken with a viable fetus. Maternal hyperthyroidism increases fetal risk in the setting of LT, particularly in the setting of thyrotoxicosis. We report the first case of propylthiouracil-induced acute liver failure in a hyperthyroid patient in her second trimester resulting in LT. The multidisciplinary management led to a favorable outcome for the patient and the subsequent delivery of a healthy infant at 38-weeks' gestation. •Drug-induced liver failure can be managed successfully during pregnancy.•Management of hyperthyroidism during liver transplantation can be bridged with MARS therapy using a multidisciplinary team and a step-wise approach in the right clinical setting.•Liver transplantation proved successful for a pregnant woman at 19 weeks' gestation who developed liver failure secondary to propylthiouracil-induced drug injury in the setting of hyperthyroidism.