title: Successful treatment for a patient with hemophagocytic syndrome after a small-for-size graft liver transplantation.
abstract: Hemophagocytic syndrome (HPS) is a hematological disorder caused by activated T lymphocytes, which leads to the proliferation of stimulated macrophages that phagocytose and destroy circulating blood elements and their precursors within bone marrow, and lead to the further production of inflammatory cytokines. Living donor liver transplantation (LDLT) between adults has been performed to compensate for the shortage of available organs. There have been some reports concerning HPS after LDLT; however, its prognosis is disappointingly poor. In particular, there is no report of treated HPS developed after LDLT using small-for-size left lobe grafts. We herein report a case of HPS in a 63-year old woman who underwent LDLT using left lobe graft weighing only 330g. The HPS was diagnosed on postoperative day 13, and was successfully treated using a combination of intravenous immunoglobulin, granulocyte colony stimulating factor, conversion of calcineurin inhibitor and steroid pulse. The trigger of HPS may not only be systemic infection, but also hypercytokinemia caused by various factors. HPS is a fatal complication in immunologically compromised patients; however, early and accurate diagnosis could lead to an adequate treatment and improve the outcome.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. yoshizumi@clin.med.tokushima-u.ac.jp
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kayashima
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Yo-ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishizaki
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D005260:Female; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery; D016031:Liver Transplantation; D051359:Lymphohistiocytosis, Hemophagocytic / Q000601:surgery*; D008875:Middle Aged; D009929:Organ Size; D012074:Remission Induction