Severe thrombotic complications associated with activated protein C resistance acquired by orthotopic liver transplantation.
We report a patient who developed recurrent hepatic artery thrombosis and deep venous thrombosis following orthotopic liver transplantation. Investigations revealed the presence of activated protein C (APC) resistance due to a mutation in the factor V gene in the transplanted liver. The patient's own peripheral blood cells did not carry the mutation. Although part of factor V is located in the platelets and may be endogenously synthesized by megakaryocytes, this case demonstrates the major clinical importance of hepatic-derived factor V. It may be reasonable to screen liver donors with a history of a thrombotic event for APC, and to consider anticoagulation in the recipients of livers positive for this defect.
Gillis
S
S
Department of Hematology, Hadassah University Hospital, Jerusalem, Israel. sgillis@md2.huji.ac.il
Lebenthal
A
A
Pogrebijsky
G
G
Levy
Y
Y
Eldor
A
A
Eid
A
A
D020016:Activated Protein C Resistance / Q000150:complications / Q000209:etiology*; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000209:etiology; D004252:DNA Mutational Analysis; D005165:Factor V / Q000235:genetics; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009154:Mutation; D013927:Thrombosis / Q000150:complications* / Q000209:etiology; D020246:Venous Thrombosis / Q000209:etiology
D005165:Factor V