{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:52:55Z","timestamp":1791251575882,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ther Apher Dial"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute\u2010on\u2010chronic liver failure (ACLF) in pregnancy is a rare, life\u2010threatening condition with high maternal and fetal mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report a twin\u2010pregnant patient with ACLF managed by a multidisciplinary team. Interventions included comprehensive medical therapy, seven sessions of artificial liver support (plasma exchange), symptom control, nutritional and psychological care, and prophylactic measures against mother\u2010to\u2010child transmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient successfully delivered healthy twins. Postdelivery, both infants tested negative for HBsAg and HBV\u2010DNA, confirming effective prevention of vertical transmission. Maternal condition stabilized with treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multidisciplinary management incorporating artificial liver therapy and tailored obstetric care can achieve favorable maternal and neonatal outcomes in ACLF during twin pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1744-9987.70230","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:10:49Z","timestamp":1791249049000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful Multidisciplinary Management of Acute\u2010On\u2010Chronic Liver Failure in a Twin Pregnancy Using Artificial Liver Support: A Case Report"],"prefix":"10.1002","author":[{"given":"Pingping","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Hangzhou First People's Hospital  Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Hangzhou First People's Hospital  Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifei","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Hangzhou First People's Hospital  Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0619-2444","authenticated-orcid":false,"given":"Lina","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Hangzhou First People's Hospital  Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"1","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12072-024-10773-4","article-title":"APASL\u2010ACLF Research Consortium (AARC) for APASL\u2010ACLF Working Party. Acute\u2010On\u2010Chronic Liver Failure (ACLF): The 'Kyoto Consensus'\u2010Steps From Asia","volume":"19","author":"Choudhury A.","year":"2025","journal-title":"Hepatology International"},{"issue":"2","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.livres.2021.03.002","article-title":"Expert Consensus on Perioperative Management of Liver Transplantation in Adults With Acute\u2010On\u2010Chronic Liver Failure","volume":"5","author":"Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association","year":"2021","journal-title":"Liver Research"},{"issue":"3","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s12072-024-10650-0","article-title":"APASL Clinical Practice Guidelines on the Management of Acute Kidney Injury in Acute\u2010On\u2010Chronic Liver Failure","volume":"18","author":"Maiwall R.","year":"2024","journal-title":"Hepatology International"},{"issue":"2","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jhep.2023.04.021","article-title":"EASL Clinical Practice Guidelines on Acute\u2010On\u2010Chronic Liver Failure","volume":"79","author":"European Association for the Study of the Liver","year":"2023","journal-title":"Journal of Hepatology"},{"issue":"5","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/CCM.0000000000005824","article-title":"Guidelines for the Management of Adult Acute and Acute\u2010On\u2010Chronic Liver Failure in the ICU: Neurology, Peri\u2010Transplant Medicine, Infectious Disease, and Gastroenterology Considerations","volume":"51","author":"Nanchal R.","year":"2023","journal-title":"Critical Care Medicine"},{"issue":"7","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1080\/01443615.2020.1824214","article-title":"Liver Failure in Pregnancy: A Review of 25 Cases","volume":"41","author":"Luo M.","year":"2021","journal-title":"Journal of Obstetrics and Gynaecology"},{"issue":"11","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.3390\/healthcare9111481","article-title":"State of the Art in Hepatic Dysfunction in Pregnancy","volume":"9","author":"Varlas V. N.","year":"2021","journal-title":"Healthcare (Basel)"},{"issue":"2","key":"e_1_2_10_9_1","first-page":"414","article-title":"Influencing Factors of Short\u2010Term Prognosis of Liver Failure During Pregnancy","volume":"35","author":"Zhang B.","year":"2019","journal-title":"Clinical Journal of Hepatobiliary Diseases"},{"key":"e_1_2_10_10_1","first-page":"9831687","article-title":"Acute\u2010On\u2010Chronic Liver Failure in Pregnant Patients With Chronic Hepatitis B: A Retrospective Observational Case Series Study","volume":"2020","author":"Wang S.","year":"2020","journal-title":"Gastroenterology Research and Practice"},{"issue":"4","key":"e_1_2_10_11_1","first-page":"788","article-title":"Clinical Features and Outcomes of HBV\u2010Related Acute\u2010On\u2010Chronic Liver Failure During Pregnancy","volume":"38","author":"Ji L.","year":"2022","journal-title":"Clinical Journal of Hepatobiliary Diseases"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S600634"},{"issue":"7","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1089\/jwh.2021.0328","article-title":"Sleep Self\u2010Report and Actigraphy Measures in Healthy Midlife Women: Validity of the Pittsburgh Sleep Quality Index","volume":"31","author":"Zak R. S.","year":"2022","journal-title":"Journal of Women's Health"},{"issue":"12","key":"e_1_2_10_14_1","first-page":"2371","article-title":"Guidelines for the Diagnosis and Treatment of Liver Failure (2024 Edition)","volume":"40","author":"Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association","year":"2024","journal-title":"Clinical Journal of Hepatobiliary Diseases"},{"issue":"10","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1007\/s00134-022-06802-1","article-title":"Artificial Liver Support in Patients With Liver Failure: A Modified DELPHI Consensus of International Experts","volume":"48","author":"Saliba F.","year":"2022","journal-title":"Intensive Care Medicine"},{"issue":"6","key":"e_1_2_10_16_1","first-page":"401","article-title":"Guidelines for the Treatment of Artificial Liver Blood Purification System ( 2023 Edition )","volume":"16","author":"Chinese Society of Infectious Diseases, Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Liver Failure and Artificial Liver Expert Committee, National Clinical Medical Research Center for Infectious Diseases","year":"2023","journal-title":"Chinese Journal of Clinical Infectious Diseases"},{"issue":"2","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.livres.2024.06.003","article-title":"Early Plasma Exchange and Continuous Renal Replacement Therapy Improve Puerperal Prognosis in Hepatitis B Virus\u2010Related Acute\u2010On\u2010Chronic Liver Failure in Pregnancy","volume":"8","author":"Li L.","year":"2024","journal-title":"Liver Research"},{"issue":"24","key":"e_1_2_10_18_1","first-page":"3218","article-title":"Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association; Nutrition and Regeneration in End\u2010Stage Liver Disease Group, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the Diagnosis and Treatment of Acute\u2010On\u2010Chronic Liver Failure (2025)","volume":"138","author":"Chen Y.","year":"2025","journal-title":"Chinese Medical Journal"},{"issue":"2","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s12072-021-10285-5","article-title":"Asian Pacific Association for the Study of Liver (APASL) Guidelines: Hepatitis B Virus in Pregnancy","volume":"16","author":"Kumar M.","year":"2022","journal-title":"Hepatology International"}],"container-title":["Therapeutic Apheresis and Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70230","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1744-9987.70230","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:10:53Z","timestamp":1791249053000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1744-9987.70230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":18,"alternative-id":["10.1002\/1744-9987.70230"],"URL":"https:\/\/doi.org\/10.1002\/1744-9987.70230","archive":["Portico"],"relation":{},"ISSN":["1744-9979","1744-9987"],"issn-type":[{"value":"1744-9979","type":"print"},{"value":"1744-9987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"assertion":[{"value":"2026-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1744-9987.70230"}}