From Crisis to Cure: Data Reveal Full-Term Delivery Possible After Liver Transplant During Pregnancy

Can a Pregnancy Survive Acute Liver Failure and Emergent Transplant?

Imagine overseeing the care of a 26-year-old pregnant woman in organ failure at just 16 weeks gestation—what now? Acute liver failure in pregnancy is rare and often fatal for both mother and fetus. But how far have our multidisciplinary teams come in making the unthinkable possible?

The Challenge: Liver Failure in Pregnancy

Acute liver failure during pregnancy poses unique clinical and ethical difficulties. The rapid onset of symptoms—jaundice, altered mental status, severe lab abnormalities—demands urgent, coordinated intervention. In most cases, supportive measures are not enough, and liver transplantation becomes the only lifeline. Despite high maternal survival rates with transplant, the chance of fetal survival, especially in the second trimester, remains uncertain. The ethical dilemma centers on balancing maternal rescue with fetal risk.

Case Snapshot: Multidisciplinary Rescue

Recently published case details a 26-year-old with acute liver failure at 14 weeks gestation, likely linked to recent IV medications. Her labs worsened despite intensive support, developing hepatic encephalopathy and coagulopathy. After multidisciplinary discussion and counseling, she underwent emergency living-donor liver transplantation at 16 weeks—an exceptionally early gestational age for such a procedure.

Surgical and Perioperative Keys

Surgical planning was individualized with maternal hemodynamic stability and preservation of uteroplacental blood flow as top priorities. Classic inferior vena cava clamping was avoided to protect fetal circulation. Anesthesia management focused on stable blood pressure and oxygenation. Immunosuppression, essential for graft survival, was carefully tailored using agents considered acceptable in pregnancy, such as low-dose steroids and tacrolimus.

From Transplant to Delivery: Maternal and Fetal Outcomes

Postoperative monitoring was rigorous. No graft or surgical complications occurred, and maternal labs normalized rapidly. Daily fetal surveillance confirmed consistently reassuring findings—normal heart tones, amniotic fluid, and growth. Gestation progressed uneventfully to 37 weeks, when a healthy boy was delivered by cesarean. Months out, both the mother’s graft function and the child’s health remained stable.

Clinical Implications: Why This Matters

This report underscores that, with prompt recognition, expert multidisciplinary management, and individualized surgical and anesthetic planning, early second-trimester liver transplantation can save both mother and child. It challenges the assumption that all such pregnancies must end in fetal loss and provides a model for team-based decision-making in similarly high-risk clinical scenarios.

Conclusion

While pregnancy complicated by acute liver failure and emergency transplantation remains rare, this case illustrates that successful maternal and fetal outcomes are possible with vigilant, collaborative care. Clinicians should recognize early signs, refer rapidly, and coordinate among specialties to optimize outcomes—potentially rewriting what’s possible for mothers and their babies.

Key Points

Acute liver failure in early pregnancy is rare but may require urgent transplantation for maternal survival.

Meticulous multidisciplinary planning is essential—obstetric, surgical, anesthesia, and neonatal teams must work together.

Individualized perioperative strategies, such as avoiding complete caval clamping, can safeguard fetal well-being.

With vigilant monitoring, healthy delivery at term is possible even after early second-trimester transplant.

Early recognition and rapid referral are crucial for maximizing both maternal and fetal outcomes.

Citation:

Rauf Melekoglu, Busra Berfin Polat, Kemal Baris Sarici, Cemalettin Koc, Duygu Demiroz, Omer Kadir Gurbuz. Emergency liver transplantation during early second-trimester pregnancy guided by an obstetric decision algorithm: a case report and review of the literature. BMC Pregnancy and Childbirth. 2026; Article in Press. DOI: https://doi.org/10.1186/s12884-026-10063-x