Motomura T, Yoshizumi T, Ohira M, Mano Y, Toshima T, Itoh S, Harada N, Harimoto N, Ikegami T, Soejima Y, Maehara Y
Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Transplant Proc. 2017 Dec;49(10):2409-2410. doi: 10.1016/j.transproceed.2017.09.014.
Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare but severe complication after liver transplantation. In contrast to other thrombotic microangiopathies, treatment for TA-TMA has yet to be clarified. A 52-year-old male patient with liver cirrhosis due to hepatitis C underwent split liver transplantation from a deceased donor. His clinical course was without complication until 4 days after transplantation, when he experienced impaired consciousness, hemolytic anemia with fragmented erythrocytes, and marked thrombocytopenia. TA-TMA was diagnosed, and recombinant thrombomodulin was administered for 4 days. The patient's clinical symptoms and laboratory data rapidly improved. He has been followed up for 6 months and has not shown any complications. The pathogenesis of TA-TMA is endothelial damage in the vasculature. Recombinant thrombomodulin, an endothelial cell-protecting agent, is a promising new therapeutic choice for TA-TMA after liver transplantation.
移植相关血栓性微血管病（TA-TMA）是肝移植后一种罕见但严重的并发症。与其他血栓性微血管病不同，TA-TMA的治疗方法尚未明确。一名因丙型肝炎导致肝硬化的52岁男性患者接受了来自已故供体的劈离式肝移植。他的临床过程在移植后4天前无并发症，之后出现意识障碍、伴有破碎红细胞的溶血性贫血和明显的血小板减少。诊断为TA-TMA，并给予重组血栓调节蛋白治疗4天。患者的临床症状和实验室数据迅速改善。他已随访6个月，未出现任何并发症。TA-TMA的发病机制是血管系统中的内皮损伤。重组血栓调节蛋白作为一种内皮细胞保护剂，是肝移植后TA-TMA一种有前景的新治疗选择。
