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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Acute fatty liver of pregnancy (AFLP) is a rare yet serious complication that can lead to maternal and fetal morbidity if not recognized early. It typically presents in the third trimester, but early-onset cases are uncommon and often more difficult to diagnose. The condition results from microvesicular fatty infiltration of hepatocytes, leading to liver failure and metabolic derangements. This case describes an unusual second-trimester presentation of AFLP successfully managed with the Dual Plasma Molecular Adsorption System (DPMAS), which provided effective hepatic support until recovery.
A 36-year-old woman, gravida 3 para 1, at 15 6/7 weeks of gestation was admitted for progressive jaundice, abdominal discomfort, and dark-colored urine for three weeks. She was icteric but had no hepatosplenomegaly. Laboratory results showed ALT 1320.9 U/L, AST 1042.5 U/L, total bilirubin 338.9 µmol/L (direct 208.1 µmol/L), PT 22.1 seconds, INR 1.92, and plasma ammonia 69 µmol/L. Viral hepatitis markers were negative, and abdominal ultrasound revealed mild hepatic steatosis with a viable fetus.
Autoimmune hepatitis and intrahepatic cholestasis were ruled out. Based on the Swansea criteria, a diagnosis of AFLP was made. The patient was started on supportive therapy including Minophagen infusion, ursodeoxycholic acid, vitamin K, antibiotics, methyldopa, and folate. Due to worsening liver function, DPMAS hemoperfusion was initiated to aid hepatic detoxification.
DPMAS treatment was performed in three consecutive sessions. Plasma was separated, passed through the BS330 bilirubin adsorption and HA330-II resin cartridges, and then reinfused. This system removes bilirubin, bile acids, ammonia, and inflammatory mediators. The procedure was done under close monitoring by a multidisciplinary team composed of nephrology, gastroenterology, and obstetrics services.
After DPMAS therapy, a significant improvement in liver function was observed. Total bilirubin dropped from 388.1 µmol/L to 145.8 µmol/L within seven days, while transaminases decreased from ALT 769 to 40 U/L and AST 445 to 43 U/L. Coagulation parameters normalized, and the patient’s jaundice, nausea, and malaise resolved. No signs of hepatic encephalopathy or renal dysfunction developed during her hospital stay.
She was discharged in stable condition with normalizing liver function tests on follow-up. Six months later, she delivered a healthy full-term baby girl without complications. The favorable outcome highlighted the effectiveness of DPMAS in reversing severe hepatic injury and supporting recovery in pregnancy-related liver failure.
This case illustrates an uncommon early-onset presentation of AFLP successfully treated with DPMAS. Early diagnosis, careful exclusion of other hepatic disorders, and prompt initiation of extracorporeal therapy were essential to achieving good maternal and fetal outcomes.
DPMAS effectively reduced bilirubin and hepatic toxins, improved coagulation, and prevented progression to hepatic failure when pregnancy termination was not yet an option. Although AFLP is classically a late-pregnancy condition, clinicians should maintain vigilance for earlier occurrences. DPMAS may serve as a valuable adjunct in managing severe hepatic dysfunction during pregnancy, offering a bridge to recovery until liver function normalizes.
