Kimura Koichi, Yoshizumi Tomoharu, Itoh Shinji, Harimoto Norifumi, Motomura Takashi, Harada Noboru, Nagatsu Akihisa, Ikegami Toru, Ninomiya Mizuki, Soejima Yuji, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
Surg Case Rep. 2016 Dec;2(1):81. doi: 10.1186/s40792-016-0208-8. Epub 2016 Aug 6.
Disseminated intravascular coagulation (DIC) after liver transplantation (LT) is a difficult complication. We report a case of disseminated intravascular coagulation after deceased donor liver transplantation (DDLT) treated with recombinant thrombomodulin (rTM).
A 30-year-old woman underwent right tri-segment split graft DDLT for acute liver failure. She developed disseminated intravascular coagulation on post-operative day 5 with fever. Computed tomography revealed necrosis of hepatic segment IV, and her acute-phase disseminated intravascular coagulation score was seven points. She was given rTM, and the inflammation, liver function, and coagulation disorders immediately improved. However, pleural effusion drainage from the chest tube became bloody on post-operative day 11, and rTM was discontinued. She progressed well and was discharged from the hospital on post-operative day 28. rTM is an effective treatment for disseminated intravascular coagulation; however, rTM for cases with coagulation disorders, which can occur after liver transplantation, has both risks and benefits.
We report a case of DIC after LT, in which rTM was potentially effective. Further studies are needed to determine the appropriate dosages, duration, and additional considerations for rTM therapy in liver transplantation patients.
肝移植（LT）后发生的弥散性血管内凝血（DIC）是一种棘手的并发症。我们报告一例在接受重组血栓调节蛋白（rTM）治疗的脑死亡供体肝移植（DDLT）后发生弥散性血管内凝血的病例。
一名30岁女性因急性肝衰竭接受了右三叶劈裂式移植物DDLT。她在术后第5天出现发热并发生弥散性血管内凝血。计算机断层扫描显示肝IV段坏死，其急性期弥散性血管内凝血评分为7分。给予她rTM后，炎症、肝功能和凝血障碍立即得到改善。然而，术后第11天胸腔引流管引出的胸腔积液变为血性，于是停用rTM。她恢复良好，术后第28天出院。rTM是治疗弥散性血管内凝血的有效药物；然而，对于肝移植后可能出现的凝血障碍病例，使用rTM有风险也有获益。
我们报告了一例肝移植后发生DIC的病例，其中rTM可能有效。需要进一步研究以确定肝移植患者rTM治疗的合适剂量、疗程及其他注意事项。
