The impact of plasma exchange on severe liver disease in pregnancy

Professor Catherine Williamson, Shahina Begum

Tommy’s researchers are finding out if total plasma exchange (TPE) is beneficial for women with severe liver disease.

Women with severe liver disease in pregnancy have limited options for managing their conditions. There are not many suitable medications and surgical intervention is not recommended.

Symptoms of severe liver disease include itching (which is often more noticeable on the palms of the hands and soles of the feet), fatigue, and jaundice. Blood tests reveal multiple anomalies, including raised liver enzymes and bile acids. 

Studies of intrahepatic cholestasis of pregnancy (ICP) have shown that high levels of bile acids are associated with worse outcomes for the baby, including premature birth and stillbirth. 

Total plasma exchange (TPE) has been used as a treatment for a number of serious conditions. Outside of pregnancy, TPE is used for liver conditions such as acute fatty liver and paracetamol toxicity. 

Total plasma exchange involves separating the circulating blood into its component parts and removing the plasma which contains the harmful liver enzymes and bile acids. This plasma is then replaced with either a synthetic protein solution or donated plasma. 

So far, we have performed the procedure on four pregnant women with severe ICP and have analysed the effect on their itching and blood results. 

We found that all of the women felt an improvement in their symptoms, although the duration was limited. The harmful plasma was removed during the procedure, but the majority re-accumulated within days. We found that levels of bile acids did not increase further in women who continued to undergo TPE. 

We are currently analysing these results to determine whether the benefits of total plasma exchange outweigh the risks for women with severe liver disease in pregnancy. 

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Funding

This research is funded by Tommy's and ICP Support.

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