Karadagi Ahmad, Romano Antonio, Ajne Gunilla, Ericzon Bo-Göran, Nowak Greg
Division of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
Division of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
Transplant Proc. 2020 Mar;52(2):644-646. doi: 10.1016/j.transproceed.2019.10.037. Epub 2020 Feb 5.
Eclampsia with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a rare complication of pregnancy. HELLP syndrome may occur up to a week postpartum in women with eclampsia. CASE REPORT: We report a case of liver transplantation with the organ procured from a pregnant (gestation week 28) female donor who suffered brain death after cerebellar hemorrhage owing to eclampsia. Liver function tests were normal at the time of liver procurement. The liver graft was matched to a 62-year-old man with primary sclerosing cholangitis. On day 7 after an uneventful transplantation, the recipient presented with increased aminotransferases and severe thrombocytopenia. The recipient also developed hypertension and hyperthermia and a clinical picture of HELLP syndrome. The patient underwent emergency liver retransplantation on day 12 after the first transplantation. Intraoperatively, massive necrosis of the liver graft with diffuse subcapsular hematomas was seen. CONCLUSIONS: It appears that in our case, HELLP syndrome was transferred to and occurred in a male recipient. Eclampsia in the donor without overt HELLP syndrome may persist and be transferred by liver graft, developing into HELLP syndrome even in a male recipient. Therefore, liver grafts from female donors with eclampsia should be used with caution. Emergency retransplantation may be necessary.
伴有溶血、肝酶升高和血小板减少（HELLP）综合征的子痫是一种罕见的妊娠并发症。HELLP综合征可能在子痫患者产后一周内发生。病例报告：我们报告一例肝移植病例，其肝脏器官取自一名怀孕28周的女性供体，该供体因子痫导致小脑出血后发生脑死亡。获取肝脏时肝功能检查正常。肝脏移植物与一名患有原发性硬化性胆管炎的62岁男性匹配。在一次顺利的移植术后第7天，受者出现转氨酶升高和严重血小板减少。受者还出现高血压和高热，呈现出HELLP综合征的临床表现。患者在首次移植术后第12天接受了急诊肝再次移植。术中可见肝脏移植物大量坏死并伴有弥漫性包膜下血肿。结论：在我们的病例中，似乎HELLP综合征转移至男性受者并在其体内发生。供体无明显HELLP综合征的子痫可能持续存在，并通过肝脏移植物转移，即使在男性受者中也会发展为HELLP综合征。因此，来自患有子痫的女性供体的肝脏移植物应谨慎使用。可能需要进行急诊再次移植。
