title: Successful renal transplantation in a patient with heterozygous prothrombin gene, factor V Leiden mutation and heparin-induced thrombocytopenia using r-hirudin as anticoagulant.
abstract: Vascular complications remain the most common cause of early renal allograft loss in patients with end-stage renal failure. Underlying thrombophilic disorders increase the risk of early graft thrombosis. A male adolescent with high-risk thrombophilia because of combined heterozygous factor V Leiden (G1691A) and prothrombin gene (G20210A) mutation developed HIT II. Hemodialysis and subsequent renal transplantation were undertaken using recombinant hirudin, a direct and selective thrombin inhibitor, as an anticoagulant. Primary function in the transplanted kidney was excellent. No thrombotic or hemorrhagic events have occurred and follow-up showed excellent long-term graft survival. Patients on HD have an increased risk for the development of HIT, and therefore, they need repetitive screening for the development of acquired thrombotic risk factors (e.g. HIT II or lupus anticoagulant). R-hirudin is efficacious and safe on both HD and following renal transplantation.
authors.affiliation: Department of Pediatric Nephrology, Friedrich-Schiller-University Jena, Jena, Germany. ulrike.john@med.uni-jena.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: John
authors.forename: Karim
authors.initials: K
authors.lastname: Kentouche
authors.forename: Goetz
authors.initials: G
authors.lastname: Nowak
authors.forename: Jörg
authors.initials: J
authors.lastname: Schubert
authors.forename: Joachim
authors.initials: J
authors.lastname: Misselwitz
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects; D005165:Factor V / Q000235:genetics*; D005343:Fibrinolytic Agents / Q000494:pharmacology; D005500:Follow-Up Studies; D006493:Heparin / Q000009:adverse effects*; D006579:Heterozygote; D006629:Hirudins / Q000494:pharmacology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009154:Mutation; D011516:Prothrombin / Q000235:genetics*; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy; D019851:Thrombophilia / Q000150:complications / Q000235:genetics
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006629:Hirudins; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin; D006493:Heparin