General and Digestive Surgery Department, Hospital Universitario Cruces, Bizkaia, Spain.
Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, Spain.
Lupus. 2021 Apr;30(4):669-673. doi: 10.1177/0961203320983450. Epub 2021 Jan 6.
Transplantation-mediated alloimmune thrombocytopenia (TMAT) is a rare complication affecting the recipient of an organ from a donor with immune thrombocytopenia (ITP).
We present a case of TMAT following liver transplantation successfully treated by retransplantation, along with a review of previously published cases.Clinical presentation: The liver donor had lupus and ITP and died from an intracranial hemorrhage. The recipient's platelet count fell to x10/L on postoperative day 2. Due to the lack of response to medical treatment, emergency retransplantation was undertaken with a steady recovery of the platelet count within a few days.
Six additional cases of transplantation-mediated alloimmune thrombocytopenia after liver transplantation have been reported. In all cases, severe thrombocytopenia ensued within 3 days after liver transplantation. Four patients suffered hemorrhagic complications. Three patients died. Early retransplantation was needed in three out of four patients receiving a graft from a donor with ITP and splenectomy. All recovered shortly after the new graft was in place.
Severe refractory transplantation-mediated alloimmune thrombocytopenia can develop in liver recipients from donors with ITP, especially those with previous splenectomy. Early retransplantation should be considered if there is no rapid response to medical therapy.
移植介导的同种免疫性血小板减少症（TMAT）是一种罕见的并发症，影响接受来自免疫性血小板减少症（ITP）供体的器官的受者。
我们报告了一例肝移植后 TMAT 的病例，该病例通过再次移植成功治疗，并对以前发表的病例进行了回顾。临床表现：肝供体患有狼疮和 ITP，并因颅内出血而死亡。受者的血小板计数在术后第 2 天降至 x10/L。由于对药物治疗无反应，紧急进行了再次移植，几天后血小板计数稳定恢复。
在肝移植后，又报告了 6 例 TMAT。在所有情况下，肝移植后 3 天内均出现严重血小板减少症。4 例患者发生出血并发症。3 例患者死亡。在从 ITP 供体接受供体且接受脾切除术的 4 例患者中，有 3 例患者需要早期再次移植。所有患者在新移植物到位后很快恢复。
来自 ITP 供体的肝移植受者可能会发生严重的难治性移植介导的同种免疫性血小板减少症，尤其是那些之前接受过脾切除术的患者。如果对药物治疗没有快速反应，应考虑早期再次移植。
