Transfusion-free Retransplantation for Post-liver Transplantation Hepatic Artery Thrombosis: How Much Augmentation Is Too Much?

Autor:	Mulgaonkar A; Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA., Horwich B; Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA., Kim B; Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA., Kahn JA; Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA., Kaur N; USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA., Genyk Y; USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA., Han H; Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA., Ahearn A; USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Jazyk:	angličtina
Zdroj:	Transplantation direct [Transplant Direct] 2021 Oct 22; Vol. 7 (11), pp. e776. Date of Electronic Publication: 2021 Oct 22 (Print Publication: 2021).
DOI:	10.1097/TXD.0000000000001123
Abstrakt:	Liver transplantation presents unique challenges in patients who do not accept blood transfusions. The difficulty of balancing chemical augmentation and handling the technical difficulty of the surgery make transfusion-free liver transplantation an exception rather than the norm. However, at our center, we have performed 27 successful living donor liver transplants in transfusion-free patients. We describe a case of hepatic artery thrombosis (HAT) after living donor liver transplantation requiring retransplantation. This first report of safe retransplantation without blood products demonstrates that even graft-threatening complications can be safely managed in a transfusion-free setting. However, it remains unclear if the medical augmentation to meet hematologic and coagulation parameters before transfusion-free transplantation may increase the risk of postoperative HAT and other thrombotic complications. Although it is our center's experience that the thrombosis rate is comparable with the published rate in standard transfusion-eligible living donor liver transplantations and this case demonstrates that HAT can be safely managed in this setting, further study on the risks and benefits of hematopoietic stimulants as pretransplant optimization is warranted. Competing Interests: The authors declare no funding or conflicts of interest. (Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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