A report of outcomes after orthotopic liver transplant with allografts from heparin antibody-positive donors.
Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition associated with thrombocytopenia and thrombotic complications. The condition is increasingly recognized in hospitalized patients including severely injured trauma patients. Because these patients may eventually be considered for organ donation, management of the HIT screenpositive donor has become an important issue in transplant surgery. We describe the recent management of 2 liver allograft donors with relative thrombocytopenia and positive HIT antibody screens. In both cases, systemic anticoagulation at the organ recovery operation was accomplished with argatroban, a synthetic thrombin inhibitor. This management strategy resulted in successful transplants for 7 recipients (1 heart, 2 liver, 4 kidney). Neither of the liver recipients demonstrated signs or symptoms of HIT, and neither had any postoperative thrombotic complications. Based on this experience, a treatment algorithm for managing HIT-positive donors is proposed. In addition, the pathophysiology of HIT and various testing modalities for the disorder are discussed.
Division of Abdominal Transplantation and Hepatobiliary Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. taaloia@tmhs.org
Thomas A
TA
Aloia
John A
JA
Goss
D000465:Algorithms; D000906:Antibodies / Q000097:blood*; D000925:Anticoagulants / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D002985:Clinical Protocols; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010875:Pipecolic Acids / Q000627:therapeutic use*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000276:immunology / Q000517:prevention & control*; D013927:Thrombosis / Q000139:chemically induced / Q000276:immunology / Q000517:prevention & control*; D014019:Tissue Donors; D014184:Transplantation, Homologous; D055815:Young Adult
D000906:Antibodies; D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban