Thromboembolic risk assessment in a phenotypically cured factor-V-Leiden carrier after orthotopic liver transplantation.
BACKGROUND
The factor V Leiden mutation is a common genetic risk factor for thromboembolism. After liver transplantation, patients may present with an acquired factor V phenotype - genotype discrepancy.


METHODS
We present the history of a heterozygous carrier of the factor V Leiden mutation who needed liver transplantation because of coumarin-induced acute liver failure. This led to a phenotype - genotype discrepancy with apparent cure from the factor V Leiden carrier status.


CONCLUSIONS
To date the thromboembolic risk assessment regarding the need for postoperative prophylactic anticoagulation in such patients has remained controversial with respect to the intracellular fraction of factor V in platelets. However, recent observations have shown that platelet factor V Leiden is endocytosed by megacaryocytes from plasma. Therefore, former assessments of an ongoing risk for thromboembolic events despite apparent cure of the factor V Leiden carrier status after liver transplantation should be corrected.
Strobel
Julian
J
Department of Transfusion Medicine and Hemostaseology, University Hospital Erlangen, Erlangen, Germany. julian.strobel@uk-erlangen.de
Ringwald
Juergen
J
Zimmermann
Robert
R
Eckstein
Reinhold
R
D000410:Alanine Transaminase / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D002353:Carrier State; D005165:Factor V / Q000235:genetics*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D010644:Phenprocoumon / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology*
D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D010644:Phenprocoumon