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Thrombotic microangiopathy caused by severe graft dysfunction after living donor liver transplantation: report of a case

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Abstract

Thrombotic microangiopathy (TMA) is a life-threatening complication after transplantation including liver transplantation, and its typical clinical picture is characterized by hemolytic anemia, thrombocytopenia, renal dysfunction, neurological abnormalities, and fever. We report the case of a 56-year-old female with end-stage liver disease who underwent living donor liver transplantation (LDLT), and whose postoperative course was characterized by renal failure and progressive hyperbilirubinemia. Two weeks after LDLT, she started to show progressive thrombocytopenia, anemia, oliguria, and encephalopathy. From these clinical manifestations, she was diagnosed as having TMA and underwent plasma exchanges with continuous hemodialysis under temporary holding calcineurin inhibitors. The patient promptly responded to the treatment, with improved hematological, hepatic, and renal conditions, and was discharged from hospital a month later in a stable condition. We describe this case of TMA after LDLT with poor graft function and extensively review the disease in liver transplant recipients.

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Abbreviations

TMA:

Thrombotic microangiopathy

LDLT:

Living donor liver transplantation

AIH:

Autoimmune hepatitis

PBC:

Primary biliary cirrhosis

CNI:

Calcineurin inhibitor

POD:

Postoperative day

PE:

Plasma exchange

CHDF:

Continuous hemodiafiltration

ADAMTS13:

A disintegrin-like and metalloproteinase with thrombospondin type-1 motifs 13

vWF:

von Willebrand factor

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Disclosures

Conflict of Interest:

The authors declare that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Daisuke Matsuda, Takeo Toshima, Toru Ikegami, Norifumi Harimoto, Yo-ichi Yamashita, Tomoharu Yoshizumi, Yuji Soejima, Tetsuo Ikeda, Ken Shirabe & Yoshihiko Maehara

Authors
  1. Daisuke Matsuda
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  2. Takeo Toshima
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  3. Toru Ikegami
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  4. Norifumi Harimoto
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  5. Yo-ichi Yamashita
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  6. Tomoharu Yoshizumi
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  7. Yuji Soejima
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  8. Tetsuo Ikeda
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  9. Ken Shirabe
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  10. Yoshihiko Maehara
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Corresponding author

Correspondence to Takeo Toshima.

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Matsuda, D., Toshima, T., Ikegami, T. et al. Thrombotic microangiopathy caused by severe graft dysfunction after living donor liver transplantation: report of a case. Clin J Gastroenterol 7, 159–163 (2014). https://doi.org/10.1007/s12328-013-0446-2

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  • DOI: https://doi.org/10.1007/s12328-013-0446-2

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