title: Renal transplantation experience in a patient with factor V Leiden homozygous, MTHFR C677T heterozygous, and PAI heterozygous mutation.
abstract: Vascular complications are important causes of allograft loss in renal transplantation. A two and a half-month-old boy was diagnosed with posterior urethral valve and progressed to end-stage renal disease at eight yr of age. During the HD period, a central venous catheter was replaced three times for repeated thrombosis. The boy was found to be homozygous for FVL and heterozygous for both MTHFR (C677T) and PAI. At the age of 12, renal transplantation was performed from a deceased donor. Postoperative anticoagulation therapy was initiated with continuous intravenous administration of heparin at the dose of 10 IU/kg/h. HD was performed for the first three days. By the fourth day of transplantation, his urine output had increased gradually. Heparin infusion was continued for 18 days during hospitalization at the same dosage. Thereafter, he was discharged with LMWH. On the third month after transplantation, his serum creatinine level was 1.1 mg/dL and eGFR was 75.7 mL/min/1.73 m(2). He has still been using LMWH, and his eGFR was 78.7 mL/min/1.73 m(2) eight months after transplantation. Postoperative low-dose heparin treatment is a safe strategy for managing a patient with multiple thrombotic risk factors.
authors.affiliation: Department of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey.
authors.forename: Bora
authors.initials: B
authors.lastname: Gülhan
authors.affiliation: Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey.
authors.forename: Betül
authors.initials: B
authors.lastname: Tavil
authors.affiliation: Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Gümrük
authors.affiliation: Department Urology, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey.
authors.forename: Tuncay F
authors.initials: TF
authors.lastname: Aki
authors.affiliation: Department of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey.
authors.forename: Rezan
authors.initials: R
authors.lastname: Topaloglu
mesh_terms: D002405:Catheterization, Central Venous; D002648:Child; D003404:Creatinine / Q000097:blood; D005165:Factor V / Q000235:genetics*; D005919:Glomerular Filtration Rate; D006493:Heparin / Q000627:therapeutic use; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D008875:Middle Aged; D009154:Mutation; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics*; D051437:Renal Insufficiency / Q000235:genetics / Q000601:surgery; D012307:Risk Factors; D019851:Thrombophilia / Q000235:genetics; D013927:Thrombosis / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C095381:factor V Leiden; D005165:Factor V; D006493:Heparin; D003404:Creatinine; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2)
keywords: factor V Leiden; renal transplantation; thrombophilia