title: Thrombotic microangiopathy caused by severe graft dysfunction after living donor liver transplantation: report of a case.
abstract: Thrombotic microangiopathy (TMA) is a life-threatening complication after transplantation including liver transplantation, and its typical clinical picture is characterized by hemolytic anemia, thrombocytopenia, renal dysfunction, neurological abnormalities, and fever. We report the case of a 56-year-old female with end-stage liver disease who underwent living donor liver transplantation (LDLT), and whose postoperative course was characterized by renal failure and progressive hyperbilirubinemia. Two weeks after LDLT, she started to show progressive thrombocytopenia, anemia, oliguria, and encephalopathy. From these clinical manifestations, she was diagnosed as having TMA and underwent plasma exchanges with continuous hemodialysis under temporary holding calcineurin inhibitors. The patient promptly responded to the treatment, with improved hematological, hepatic, and renal conditions, and was discharged from hospital a month later in a stable condition. We describe this case of TMA after LDLT with poor graft function and extensively review the disease in liver transplant recipients.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsuda
authors.forename: Takeo
authors.initials: T
authors.lastname: Toshima
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000150:complications*; D012720:Severity of Illness Index; D057049:Thrombotic Microangiopathies / Q000209:etiology*