Transfusion-free Retransplantation for Post–liver Transplantation Hepatic Artery Thrombosis: How Much Augmentation Is Too Much?

Ashwini Mulgaonkar, MD; Brian Horwich, MD; Brian Kim, MD; Jeffrey A. Kahn, MD; Navpreet Kaur, MD; Yuri Genyk, MD; Hyosun Han, MD; Aaron Ahearn, MD, PhD

doi:10.1097/TXD.0000000000001123

Transplantation Direct (Nov 2021)

Transfusion-free Retransplantation for Post–liver Transplantation Hepatic Artery Thrombosis: How Much Augmentation Is Too Much?

Ashwini Mulgaonkar, MD,
Brian Horwich, MD,
Brian Kim, MD,
Jeffrey A. Kahn, MD,
Navpreet Kaur, MD,
Yuri Genyk, MD,
Hyosun Han, MD,
Aaron Ahearn, MD, PhD

Affiliations

Ashwini Mulgaonkar, MD: 1 Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Brian Horwich, MD: 1 Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Brian Kim, MD: 1 Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Jeffrey A. Kahn, MD: 1 Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Navpreet Kaur, MD: 3 USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Yuri Genyk, MD: 3 USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Hyosun Han, MD: 1 Department of Internal Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.
Aaron Ahearn, MD, PhD: 3 USC Transplant Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.

DOI: https://doi.org/10.1097/TXD.0000000000001123
Journal volume & issue: Vol. 7, no. 11
p. e776

Abstract

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Liver transplantation presents unique challenges in patients who do not accept blood transfusions. The difficulty of balancing chemical augmentation and handling the technical difficulty of the surgery make transfusion-free liver transplantation an exception rather than the norm. However, at our center, we have performed 27 successful living donor liver transplants in transfusion-free patients. We describe a case of hepatic artery thrombosis (HAT) after living donor liver transplantation requiring retransplantation. This first report of safe retransplantation without blood products demonstrates that even graft-threatening complications can be safely managed in a transfusion-free setting. However, it remains unclear if the medical augmentation to meet hematologic and coagulation parameters before transfusion-free transplantation may increase the risk of postoperative HAT and other thrombotic complications. Although it is our center’s experience that the thrombosis rate is comparable with the published rate in standard transfusion-eligible living donor liver transplantations and this case demonstrates that HAT can be safely managed in this setting, further study on the risks and benefits of hematopoietic stimulants as pretransplant optimization is warranted.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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