https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.14531

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.31559

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases.

The effect of successful liver transplantation on menstrual function was assessed by questionnaire in 44 women transplanted for various types of end stage liver disease, acute liver failure or malignant disease. Significant amenorrhoea (greater than one year) was present in 48% of women with chronic liver disease before transplantation, and was reversed within 10 months of surgery in all but one of the premenopausal patients who had primary amenorrhoea and hypogonadotrophic hypogonadism. Two patients became pregnant five months and 1.5 years after transplantation, but in one instance the pregnancy was unsuccessful, possibly as a consequence of cyclosporin related intrauterine growth retardation.

Recovery of Menstruation and Pregnancy after Liver Transplantation

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. Patients with NAFLD are at a higher risk of developing cardiovascular disease (CVD). In fact, CVD-related mortality is more common in patients with NAFLD in comparison to liver-related mortality. This association is related to the common metabolic risk factors such as obesity, dyslipidemia, diabetes, and hypertension shared by both NAFLD and CVD, and also there is independent association of NAFLD with CVD because of risk factors such as insulin resistance, systemic inflammation, and atherogenic dyslipidemia. While there is abundant literature on association of NAFLD with CVD, there is sparse literature regarding the screening for CVD in patients with NAFLD. In the current review article, we discuss as to which patients with NAFLD to screen and how to screen for CVD.

Screening of Cardiovascular Disease in Nonalcoholic Fatty Liver Disease: Whom and How?

Liver disease in pregnancy may present as a disorder that is unique to pregnancy or as an acute or chronic liver disease occurring coincidentally in pregnancy. Hepatic diseases that are unique to pregnancy include hyperemesis gravidarum; preeclampsia/eclampsia; the syndrome of hemolysis, elevated liver enzymes, and low platelets; intrahepatic cholestasis of pregnancy; and acute fatty liver of pregnancy. Acute and chronic forms of primary hepatic disorders that are seen in pregnancy include viral hepatitis, autoimmune hepatitis, nonalcoholic fatty liver disease, and cirrhosis. Because of the need to consider both maternal and fetal health, there are special considerations for the implementation of diagnostic strategies and pharmacologic therapies for liver disease that occurs in pregnancy. An understanding of the pathogenesis and expression of liver diseases in pregnancy has been evolving, and various diagnostic and prognostic tools have been studied in order to determine noninvasive approaches to identifying and staging of such diseases. Investigations have also been underway to evaluate the safety and utility of existing and new therapeutic agents that previously were thought to not be compatible with pregnancy. This review will explore updates in the epidemiology, diagnosis, and management of various liver diseases seen in pregnancy.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep4.1470

Liver Disease in Pregnancy: What's New

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/lt.24679

Evaluation of coronary artery disease in potential liver transplant recipients.

Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women With Chronic Liver Disease.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/lt.25034

Successful pregnancy outcomes following liver transplantation is predicted by renal function

Response to Mahla et al.

<h3>Background</h3> Autoimmune hepatitis (AIH) affects women of reproductive age and data on pregnancy outcomes provide insight into managing this complex condition. Specifically, the effect of cirrhosis and immunosuppression use in AIH pregnancy would aid clinicians and women with pregnancy planning. This study aims to provide patient level data on pregnancy outcomes in AIH. <h3>Method</h3> A prospective database of self-reported pregnancies from women with liver disease was reviewed to identify AIH pregnancies. Medical records were used to gather retrospective data on demographics, preconception counselling, pregnancy outcomes, serological and biochemical markers. <h3>Results</h3> Between 1983 and 2022, there were 126 pregnancies from 74 women with AIH at King’s College Hospital. Mean age at conception was 28 years and women with cirrhosis were significantly younger (p=0.48). There were 64 pregnancies from 41 women with cirrhosis at conception. Women who received pre-pregnancy counselling (n=32) were more likely to have a surveillance gastroscopy (p=0.03). The majority of patients were on immunosuppression (IS) at conception with 38 pregnancies on monotherapy, 50 on dual and 7 on triple IS. During gestation, there were no changes to IS in 90 pregnancies. 25 were not on IS at conception of which 2 were started on IS during pregnancy. The IS was reduced or stopped in 4 pregnancies. Complications in pregnancy were not increased in those with cirrhosis or on IS. There were 32 post-partum loss of biochemical remission (LOBR) of which 10 were not on IS. LOBR resulted in 1 fulminant liver failure requiring liver transplantation and 1 decompensation with ascites. A total of 99 live births (LB) were reported of which 15 were preterm birth (PTB) (32- 37 weeks gestation) and 2 very preterm (&lt;32 gestation). The rate of miscarriages, stillbirths and PTB were not increased in those with cirrhosis or IS. Preconception albumin-bilirubin score (ALBI) and AST to platelet ratio index (APRI) was predictive of LB with area under receiver operator curve of 0.7547 (p=0.0011) and 0.700 (p=0.0123) respectively. ALBI cut-off of -2.870 has sensitivity of 78.95% and specificity of 67.31% for predicting LB whereas APRI cut-off of 0.305 has sensitivity of 72.22% and specificity of 56%. <h3>Conclusion</h3> Women with AIH including those with cirrhosis can expect favourable pregnancy outcomes. Women with preconception counselling were more likely to receive surveillance endoscopy. The continued use of immunosuppression did not increase adverse pregnancy outcomes and may reduce post-partum LOBR. The ALBI and APRI scores may be useful as prognostic tools. 

Enoka S. Gonsalkorala

Papers

Evaluation of coronary artery disease in potential liver transplant recipients.

Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women With Chronic Liver Disease.

Successful pregnancy outcomes following liver transplantation is predicted by renal function

Response to Mahla et al.

P10 Pregnancy outcomes in autoimmune hepatitis from a single tertiary centre