title: Massive Fulminant Thrombosis During Liver Transplantation in a Patient With a Previously Unknown Antithrombin Pathway Mutation.
abstract: We describe a case of fulminant intraoperative thrombosis during deceased donor liver transplantation. Despite significant medical bleeding, the patient suddenly developed diffuse thrombosis in all chambers of the heart and pulmonary vasculature resulting in intraoperative death. The patient's postmortem genetic analysis demonstrated a deleterious missense mutation in a coagulation pathway gene, SERPINC1, which codes for antithrombin III. The level of antithrombin III was not available to directly prove the causality of thrombosis, but our findings suggest that this mutation, in combination with antifibrinolytic administration in a hypercoagulable cirrhotic patient, might have contributed to the development of this catastrophic thrombotic event.
authors.affiliation: From the *Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine/Penn State Hershey Medical Center, Hershey, Pennsylvania; †Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan; ‡Department of Pharmacology, Penn State College of Medicine/Penn State Hershey Medical Center, Hershey, Pennsylvania; and §Department of Surgery, Penn State College of Medicine/Penn State Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Bezinover
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Sugino
authors.forename: Yuka
authors.initials: Y
authors.lastname: Imamura-Kawasawa
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Bell
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
authors.forename: Piotr K
authors.initials: PK
authors.lastname: Janicki
mesh_terms: D000990:Antithrombin III / Q000235:genetics*; D058625:End Stage Liver Disease / Q000097:blood / Q000235:genetics / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D020125:Mutation, Missense; D013927:Thrombosis / Q000209:etiology* / Q000235:genetics
chemical_list: D005343:Fibrinolytic Agents; C542513:SERPINC1 protein, human; D000990:Antithrombin III