title: Donor screening algorithm for exclusion of thrombophilia during evaluation of living donor liver transplantation.
abstract: Living donor liver transplantation (LDLT) has evolved based on the premise that donor safety is most important. In 2005, we encountered a donor who developed a pulmonary embolism during the early post-operative period. As it is important for donors to be healthy, most risk factors related to perioperative thrombosis, such as obesity, age, and malignancy are used as exclusion criteria during the evaluation process. We speculated that thrombophilia not detected by conventional laboratory examinations may cause post-operative thrombotic complications and should be investigated by application of additional parameters, including protein S, protein C, antithrombin III, anti-β2-glycoprotein I antibodies (anti-β2GPI), and lupus anticoagulant. From July 2005 to June 2007, we evaluated 44 donor candidates for LDLT using our novel algorithm for screening of thrombophilia, which revealed two suspected candidates (one with low protein S, one with low protein C, and positive anti-β2GPI findings), who were subsequently excluded from the donor pool. Thereafter, all donor hepatectomies, which included two borderline donors given anticoagulants perioperatively, were performed without complications. Four donors (two suspected, two borderline) would not have been recognized without additional screening. In conclusion, we were able to detect thrombophilia and avoid donor thrombosis using additional screening criteria and our novel algorithm.
authors.affiliation: Department ofTransplant Surgery, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Ogawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Koji
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Taigo
authors.initials: T
authors.lastname: Hata
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Hideya
authors.initials: H
authors.lastname: Kamei
authors.forename: Takashi
authors.initials: T
authors.lastname: Arikawa
authors.forename: Taro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kiuchi
mesh_terms: D000328:Adult; D000465:Algorithms; D000990:Antithrombin III / Q000378:metabolism; D046148:Donor Selection; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000378:metabolism; D017293:Protein S / Q000378:metabolism; D019851:Thrombophilia / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult; D053482:beta 2-Glycoprotein I / Q000378:metabolism
chemical_list: D011486:Protein C; D017293:Protein S; D053482:beta 2-Glycoprotein I; D000990:Antithrombin III