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

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.

• Authors: Daisuke Matsuda, Takeo Toshima, Toru Ikegami, Norifumi Harimoto, Yo-Ichi Yamashita, Tomoharu Yoshizumi, Yuji Soejima, Tetsuo Ikeda, Ken Shirabe, Yoshihiko Maehara
• Journal: Clinical journal of gastroenterology (Clin J Gastroenterol) Vol. 7 Issue 2 Pg. 159-63 (Apr 2014) ISSN: 1865-7265 [Electronic] Japan
• PMID: 26183634 (Publication Type: Case Reports, Journal Article)

Topics

• Female
• Humans
• Liver Transplantation
• Living Donors
• Middle Aged
• Primary Graft Dysfunction (complications)
• Severity of Illness Index
• Thrombotic Microangiopathies (etiology)