Of the approximately one in 1000 pregnant women who develop the syndrome of
hemolysis, elevated liver
enzymes, and low platelets (HELLP), 2 to 3 per cent develop hepatic complications, including
liver failure for which
liver transplantation (LT) may be required. Between February 1, 1984, and December 31, 2006, eight women without a history of
liver disease underwent LT for complications of
HELLP syndrome. All received cadaveric grafts with a mean interval from delivery to LT of 7 days. The mean admission Child-Turcotte-Pugh score was 13.1 (class C), and the mean model for
end-stage liver disease score was 40. Manifestations of
liver failure included
encephalopathy (seven patients),
renal failure (four),
disseminated intravascular coagulation (three), and
respiratory failure (one). There were no intraoperative deaths. Complications of LT included biliary leaks (three patients), reoperation (three), and retransplantation (two). There was one death from
sepsis on postoperative day 91 and one death from
cholangitis/
sepsis more than 5 years postoperatively. After LT, 1-, 5-, and 10-year patient survival rates were 88 per cent, 88 per cent, and 65 per cent; 1-, 5-, and 10-year graft survival rates were 64 per cent, 64 per cent, and 48 per cent. This is the largest single-center report of LT for HELLP. Early recognition and transfer to a transplant center will yield best results with this challenging complication of pregnancy.