Transplantation-mediated alloimmune thrombocytopenia successfully treated by retransplantation.

Autor: Aranda Escaño E; General and Digestive Surgery Department, Hospital Universitario Cruces, Bizkaia, Spain.; Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain., Prieto Calvo M; General and Digestive Surgery Department, Hospital Universitario Cruces, Bizkaia, Spain.; Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitario Cruces, Bizkaia, Spain.; Surgery, Radiology and Medical Physics, University of the Basque Country (UPV-EHU), The Basque Country, Spain.; Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain., Perfecto Valero A; General and Digestive Surgery Department, Hospital Universitario Cruces, Bizkaia, Spain.; Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain., Ruiz Irastorza G; Department of Internal Medicine, University of The Basque Country, The Basque Country, Spain.; Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain., Gastaca Mateo M; General and Digestive Surgery Department, Hospital Universitario Cruces, Bizkaia, Spain.; Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitario Cruces, Bizkaia, Spain.; Surgery, Radiology and Medical Physics, University of the Basque Country (UPV-EHU), The Basque Country, Spain.; Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain., Valdivieso López A; General and Digestive Surgery Department, Hospital Universitario Cruces, Bizkaia, Spain.; Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitario Cruces, Bizkaia, Spain.; Surgery, Radiology and Medical Physics, University of the Basque Country (UPV-EHU), The Basque Country, Spain.; Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain.
Jazyk: angličtina
Zdroj: Lupus [Lupus] 2021 Apr; Vol. 30 (4), pp. 669-673. Date of Electronic Publication: 2021 Jan 06.
DOI: 10.1177/0961203320983450
Abstrakt: Introduction: Transplantation-mediated alloimmune thrombocytopenia (TMAT) is a rare complication affecting the recipient of an organ from a donor with immune thrombocytopenia (ITP).
Methods: We present a case of TMAT following liver transplantation successfully treated by retransplantation, along with a review of previously published cases.Clinical presentation: The liver donor had lupus and ITP and died from an intracranial hemorrhage. The recipient's platelet count fell to 2 x10 9 /L on postoperative day 2. Due to the lack of response to medical treatment, emergency retransplantation was undertaken with a steady recovery of the platelet count within a few days.
Discussion: Six additional cases of transplantation-mediated alloimmune thrombocytopenia after liver transplantation have been reported. In all cases, severe thrombocytopenia ensued within 3 days after liver transplantation. Four patients suffered hemorrhagic complications. Three patients died. Early retransplantation was needed in three out of four patients receiving a graft from a donor with ITP and splenectomy. All recovered shortly after the new graft was in place.
Conclusion: Severe refractory transplantation-mediated alloimmune thrombocytopenia can develop in liver recipients from donors with ITP, especially those with previous splenectomy. Early retransplantation should be considered if there is no rapid response to medical therapy.
Databáze: MEDLINE
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