Gestational alloimmune liver disease reconsidered: Advocating for a new nomenclature and enhanced diagnosis accuracy

Table 1 Gestational alloimmune liver disease cases summary table

	Case 1	Case 2	Case 3	Case 4
Mothers’ characteristics	26-year-old, gravida 2, para 2	34-year-old, gravida 5, para 3A2	31-year-old, gravida 2, para 1A1	32-year-old, gravida 2, para 0A1, N-methyl-D-aspartate encephalitis at 30 gestation weeks
Antenatal findings	None	Oligoamnios, asymmetric intrauterine growth restriction	None	Intrauterine growth restriction
Term of birth (weeks of gestation)	39	37	33	34
Preterm birth cause	N/A	N/A	Placental abruption	Maternal encephalitis
Major clinical presentation	Hypoglycemia	Hypoglycemia	Hypoglycemia, birth asphyxia, hepatorenal syndrome, hepatomegaly	Hypoglycemia
Laboratory findings	Thrombocytopenia, coagulopathy, hyperammonemia, iron saturation level 86%	Thrombocytopenia, cholestasis, high ferritin (4103 μg/L)	Thrombocytopenia, cholestasis, coagulopathy, hypoalbuminemia, high ferritin (3347 μg/L), iron saturation level 88%	Thrombocytopenia, cholestasis, coagulopathy, hypoalbuminemia, high ferritin (2515 μg/L)
Liver ultrasound findings	Portosystemic shunt: Patent ductus venosus	Portosystemic shunt: Patent ductus venosus	Heterogenous liver	Heterogenous liver, portosystemic shunt: Patent ductus venosus
Magnetic resonance imaging findings	Not performed	No hepatic or extrahepatic siderosis	No hepatic siderosis. Nonspecific for GALD	Hepatic siderosis
Salivary glands pathology	No iron deposits	No iron deposits	No iron deposits (Prussian blue)	No iron deposits
Liver pathology	Fibrosis, remodeling of the hepatic parenchyma, iron overload. Conclusion: GALD confirmed	Portal fibrosis, giant hepatocytes, siderosis. Conclusion: Nonspecific hepatitis	Membrane attack complex negative, fibrosis, siderosis. Conclusion: GALD confirmed	On autopsy: Fibrosis, siderosis +++, siderosis of pancreas
Treatments	Embolization of porto-systemic shunt and liver transplantation	None	Two doses of IVIG	Three doses of IVIG. Double volume exchange transfusion. Listed for liver transplantation
Outcomes	Normal liver function and normal growth	Spontaneous amelioration of liver function. Now: Normal liver function	Now: Normal liver function	Dead from cerebral hemorrhage
Subsequent pregnancy	No	No	Yes	Yes
Antenatal IVIG	N/A	N/A	Yes (14-16-18-19 weeks then every week)	Yes
Outcome for subsequent pregnancy	N/A	N/A	Healthy child	Healthy child

GALD: Gestational alloimmune liver disease; IVIG: Intravenous immunoglobulin; N/A: Not applicable.