Yang Hsiao-Hui, Ho Ching-Chun, Lee Chia-Ling, Wu Yi-Feng, Chen Yen-Cheng
Division of Pediatric Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Division of General Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Clin Transplant Res. 2024 Jun 30;38(2):145-149. doi: 10.4285/ctr.24.0002. Epub 2024 Apr 15.
Organ transplantation from donors with immune thrombocytopenia (ITP), a condition involving the autoantibody-mediated destruction of platelets, is a topic of debate due to the potential for transplantation-mediated autoimmune thrombocytopenia (TMAT), a rare but potentially fatal complication. Previous reports have described transplants from deceased liver donors with ITP who had very low platelet counts and disease largely refractory to treatment. Here, we present the first case of living kidney transplantation from a donor with ITP who underwent preoperative treatment, with concurrent splenectomy performed to reduce the long-term risk of spontaneous hemorrhage. To ensure the safety of the procedure, we monitored perioperative rotational thromboelastometry parameters and platelet counts, leading to the normalization of the donor's platelet levels. The recipient experienced an uneventful recovery of renal function without perioperative bleeding or the development of TMAT. Our report suggests that kidney transplantation from a donor with well-managed ITP is safe, and such a condition should not be considered a contraindication for donation.
来自患有免疫性血小板减少症（ITP）供体的器官移植是一个备受争议的话题。ITP是一种涉及自身抗体介导的血小板破坏的疾病，由于存在移植介导的自身免疫性血小板减少症（TMAT）的可能性，这是一种罕见但可能致命的并发症。既往报道描述了来自患有ITP的已故肝脏供体的移植，这些供体血小板计数极低且疾病在很大程度上难以治疗。在此，我们报告首例来自患有ITP的活体肾脏供体的移植病例，该供体接受了术前治疗，并同时进行了脾切除术以降低自发性出血的长期风险。为确保手术安全，我们监测了围手术期旋转血栓弹力图参数和血小板计数，使供体血小板水平恢复正常。受体肾功能恢复顺利，围手术期无出血，也未发生TMAT。我们的报告表明，来自ITP病情得到良好控制的供体的肾脏移植是安全的，这种情况不应被视为捐赠的禁忌证。
