4.3 Article

Transplantation-mediated alloimmune thrombocytopenia successfully treated by retransplantation

Journal

LUPUS
Volume 30, Issue 4, Pages 669-673

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/0961203320983450

Keywords

Immune thrombocytopenia; passenger lymphocyte syndrome; liver transplantation; transplantation-mediated alloimmune thrombocytopenia; TMAT

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Transplantation-mediated alloimmune thrombocytopenia (TMAT) is a rare complication in recipients of organs from donors with immune thrombocytopenia (ITP). Severe and refractory cases may require early retransplantation for successful treatment.
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 2x10(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.

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