Document Detail


Plasma exchange therapy for thrombotic thrombocytopenic purpura in pediatric patients with liver transplantation.
MedLine Citation:
PMID:  18929799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Sporadic cases of thrombotic thrombocytopenic purpura (TTP) have been reported in bone marrow and solid organ transplant patients receiving cyclosporine (CsA). We reported our experience with TTP using plasma exchange (PE) therapy in patients with liver transplantation (OLT). METHODS: Between March, 1993, and May, 2007, 400 patients underwent OLT, including 146 pediatric living-donor liver transplantation (LDLT). Four pediatric patients developed TTP after OLT: three were males and one female of mean age at the time of transplantation of 7.8 +/- 3.6 years. The four recipients had the following indications for OLT: two glycogen storage disease, one biliary atresia, and one fulminant hepatic failure. Four patients initially received triple drug immunosuppression consisting of CsA, azathioprine, and steroids. RESULTS: Four (1%) patients developed TTP after OLT. All four patients were pediatric in the age group. The mean age at the time of TTP diagnosis was 8.0 +/- 3.2 years, with a mean postoperative interval to TTP of 78.8 +/- 114.2 days. The mean baseline platelet count was 7.0 +/- 7.1 x 10,000. The eventual platelet count was 21.1 +/- 20.8 x 10,000 after PE. These patients received PE 6.0 +/- 4.2. The mean baseline serum creatinine was 0.8 +/- 0.8 mg/dL. The mean peak serum creatinine was 2.3 +/- 2.3 mg/dL. The mean serum CsA level was 717.5 +/- 106.0 ng/mL before TTP diagnosis. Four patients were diagnosed by blood peripheral smears. The causes of TTP were CsA-associated in three patients and venoocclusive disease (VOD) in one patient. Three patients improved their platelet counts after PE therapy. Two patient changed from CsA to FK 506, one underwent reduced CsA dosage, and one stopped CsA. Three patients died of recurrent VOD, infection, and intrapulmonary hemorrhage. Only one patient survived. CONCLUSIONS: The incidence of TTP in our series was lower. It only developed in pediatric patients. The causes of TTP were associated with CsA and/or VOD. The mortality was high after the TTP diagnosis. We concluded that TTP was a potentially fatal condition, but an early diagnosis with prompt institution of therapy with invasive PE therapy may reduce its mortal consequences.
Authors:
C-H Lee; C-L Chen; C-C Lin; C-H Yang; Y-F Cheng; M-C Wang; H-L Eng; P-P Liu; F-R Chuang
Related Documents :
20714839 - Poor outcome following aborted orthotopic liver transplantation due to severe porto-pul...
11738099 - Worsening of hepatic dysfunction as a consequence of repeated hydroxyethylstarch infusi...
899789 - Liver biopsies from psoriatics related to methotrexate therapy. 3. findings in post-met...
18379139 - Retrospective evaluation of serum markers apri and ast/alt for assessing liver fibrosis...
17657149 - Hemostatic alterations in liver disease: a review on pathophysiology, clinical conseque...
1999069 - Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liv...
12169989 - A severe case of ovarian hyperstimulation syndrome with liver dysfunction and malnutrit...
12167509 - Cost of treating bipolar disorder in the california medicaid (medi-cal) program.
11079539 - Nbi-5788, an altered mbp83-99 peptide, induces a t-helper 2-like immune response in mul...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  40     ISSN:  0041-1345     ISO Abbreviation:  Transplant. Proc.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-20     Completed Date:  2008-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2554-6     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Liver Transplant Program, Chang Gung Memorial Hosptial-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Child
Child, Preschool
Female
Hepatic Veno-Occlusive Disease / therapy
Humans
Liver Diseases / classification,  surgery
Liver Transplantation / adverse effects*
Male
Plasma Exchange / methods*
Postoperative Complications / epidemiology,  therapy
Purpura, Thrombotic Thrombocytopenic / therapy*
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Peroneal neuropathy after liver transplantation.
Next Document:  Living related pancreas transplantation alone with enteric drainage in Japan: case report.