Idiopathic thrombocytopenic purpura after a living-related liver transplantation.
BACKGROUND
Idiopathic thrombocytopenic purpura (ITP) is a rare complication after liver transplantation. We describe three cases of ITP in pediatric patients after a living-related liver transplantation (LRLT).


METHODS
Of 266 patients who underwent an LRLT between June 1990 and June 1996, severe thrombocytopenia developed in three pediatric patients after transplantation, and ITP was also diagnosed. The original disease was biliary atresia in all cases, and the patients were given a partial liver graft from a living-related mother and subsequently treated with tacrolimus and low-dose steroids as an immunosuppressive regimen.


RESULTS
The duration until the onset of ITP after transplantation in the three cases was 1 day, 3 months, and 13 months, respectively. The platelet-associated IgG levels increased in all cases. A preceding viral infection was suspected in two of the three cases. All patients were treated with intravenous gamma globulin with a transient recovery of thrombocytopenia in two cases and a sustained recovery in another.


CONCLUSIONS
Transplant clinicians need to be aware of the possibility of ITP complication because a sudden onset of severe thrombocytopenia can occur even in patients who are apparently doing well after undergoing an LRLT.
Department of Transplantation Immunology, Faculty of Medicine, Kyoto University, Japan.
M
M
Takatsuki
S
S
Uemoto
T
T
Kurokawa
T
T
Koshiba
Y
Y
Inomata
K
K
Tanaka
D001656:Biliary Atresia / Q000601:surgery; D001792:Blood Platelets / Q000276:immunology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors
D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous