scholarly journals A Mortality Case Caused by Thrombotic Microangiopathy after Successful Bloodless Living Donor Liver Transplantation

2021 ◽  
Vol 27 (2) ◽  
pp. 85-87
Author(s):  
Sun Young Park ◽  
Ho Bum Cho ◽  
Gyu Wan You ◽  
Kyeong Sik Kim

Thrombotic microangiopathy (TMA) after solid organ transplantation is infrequent and its etiology remains still unclear. Nevertheless, if early diagnosis and early therapies are not performed, it can lead to severe life-threatening complications and even death. A 54-year-old female (a Jehovah’s Witness) was diagnosed with drug-induced toxic hepatitis and was decided to undergo bloodless living donor liver transplantation (LDLT). After the successful LDLT, the patient’s condition deteriorated, and she was diagnosed with TMA during further evaluation. We tried to proceed with plasma exchange-based treatment, but she and her family declined according to their religious beliefs. The patient expired 4 days after the diagnosis. Physicians should maintain a high level of suspicion for TMA after liver transplantation when clinical manifestations are observed.

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 600
Author(s):  
Catherine de Magnée ◽  
Louise Brunée ◽  
Roberto Tambucci ◽  
Aurore Pire ◽  
Isabelle Scheers ◽  
...  

Background: ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been proposed to compensate for donor shortage. To date, few studies have reported detailed ABOi LDLT results in large series of pediatric patients. C4d complement deposition in graft capillaries has been reported to be associated with antibody-mediated rejection in solid organ transplantation. Methods: A retrospective case–control study was conducted, comparing clinical outcomes of each of 34 consecutive pediatric ABOi LDLT recipients with those of 2 non-ABOi pairs (n = 68), matched according to pre-transplant diagnostic criteria, age, and date of transplantation. In addition, we studied the C4d immunostaining pattern in 22 ABOi and in 36 non-ABOi recipients whose liver biopsy was performed within the first 4 post-transplant weeks for suspected acute rejection. Results: The incidence of biliary complications was higher in ABOi recipients (p < 0.05), as were the incidence of acute humoral rejection (p < 0.01) and the incidence of retransplantation (p < 0.05). All children who required retransplantation were older than 1 year at the time of ABOi LDLT. Positive C4d immunostaining was observed in 13/22 (59%) ABOi recipients versus 3/36 (8.3%) non-ABOi recipients (p < 0.0001). Conclusions: ABOi LDLT is a feasible option for pediatric end-stage liver disease but carries increased risks for the recipient, especially for children older than 1 year, even with a specific preparation protocol. C4d immunostaining may be a hallmark of acute humoral rejection in ABOi liver transplantation.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Abeer Awad Abdellatif ◽  
Mohamad Sherif Mogawer ◽  
Mostafa El- Shazli ◽  
Hanaa El-Karaksy ◽  
Ayman Salah ◽  
...  

Abstract Background Solid organ transplantation (SOT) service has been disrupted during the current coronavirus disease 2019 (COVID-19) pandemic, which deferred the service in most centers worldwide. As the pandemic persists, there will be an urgency to identify the best and safest practices for resuming activities as areas re-open. Resuming activity is a difficult issue, in particular, the decision of reopening after a period of slowing down or complete cessation of activities. Objectives To share our experience in resuming living donor liver transplantation (LDLT) in the context of the COVID-19 pandemic in the Liver Transplantation Unit of El-Manial Specialized Hospital, Cairo University, Egypt, and to review the obstacles that we have faced. Material and methods This study is a single-center study. We resumed LDLT by the 26th of August 2020 after a period of closure from the 1st of March 2020. We have taken a lot of steps in order to prevent COVID-19 transmission among transplant patients and healthcare workers (HCWs). Results In our study, we reported three LDLT recipients, once resuming the transplantation till now. All our recipients and donors tested negative for SARS-CoV-2 by nasopharyngeal RT-PCR a day before the transplantation. Unfortunately, one of them developed COVID-19 infection. We managed rapidly to isolate him in a single room, restricting one team of HCWs to deal with him with strict personal protective measures. Finally, the patient improved and was discharged in a good condition. The second patient ran a smooth course apart from FK neurotoxicity which improved with proper management. The third patient experienced a sharp rise in bilirubin and transaminases on day 14 that was attributed to drug toxicity vs. rejection and managed by discontinuing the offending drugs and pulse steroids. In addition, one of our head nurses tested positive for SARS-CoV-2 that was manageable with self-isolation. Conclusion Careful patient, donor, personnel screening is mandatory. Adequate supply of personal protective equipments, effective infection control policies, and appropriate administrative modifications are needed for a safe return of LDLT practice.


2007 ◽  
Vol 13 (10) ◽  
pp. 1455-1462 ◽  
Author(s):  
Ryohei Miyata ◽  
Motohide Shimazu ◽  
Minoru Tanabe ◽  
Shigeyuki Kawachi ◽  
Ken Hoshino ◽  
...  

2005 ◽  
Vol 80 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Sumihito Tamura ◽  
Yasuhiko Sugawara ◽  
Yuichi Matsui ◽  
Yoji Kishi ◽  
Nobuhisa Akamatsu ◽  
...  

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