Transplantation-mediated alloimmune thrombocytopenia successfully treated by retransplantation

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...

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Bibliographic Details
Published in:Lupus 2021-04, Vol.30 (4), p.669-673
Main Authors: Aranda Escaño, Elena, Prieto Calvo, Mikel, Perfecto Valero, Arkaitz, Ruiz Irastorza, Guillermo, Gastaca Mateo, Mikel, Valdivieso López, Andrés
Format: Article
Language:English
Subjects:
Hemorrhage
Idiopathic thrombocytopenic purpura
Liver
Liver transplantation
Liver transplants
Medical treatment
Organ donors
Patients
Platelets
Splenectomy
Thrombocytopenia
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Summary: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 2x109/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.
ISSN:0961-2033
1477-0962
DOI:10.1177/0961203320983450