Thrombotic microangiopathy-like disorder after living-donor liver transplantation: A single-center experience in Japan

Table 1 Recipient profiles

Recipients	ABO1	TMALD2	Clinical courses after TMALD	PE/ET3	Additional surgery4	Outcome
Pediatric	Incompatible	21	Herpes simplex sepsis	0	None	Alive
Pediatric	Incompatible	6	Pneumonitis	4	None	Alive
Adult	Identical	14	Hepatic encephalopathy, intraperitoneal bleeding	9	Surgical hemostasis (16)	Dead
Adult	Incompatible	9	Hepatic encephalopathy, brain edema gastroesophageal varices rupture, intrathoracic intraperitoneal, bleeding sepsis, aspergillus infection	8	Surgical hemostasis (21) Re-transplantation (22)	Dead
Adult	Compatible	4	Acute respiratory distress, syndrome intraperitoneal bleeding	5	None	Dead
Adult	Compatible	10	Intraperitoneal bleeding	3	Surgical hemostasis	Dead
Adult	Compatible	14	Hepatic arterial thrombosis	10	None	Dead

¹ABO blood group;

²The definite diagnosis of thrombotic microangiopathy like disorder (TMALD) [postoperative day (POD)];

³The frequency of repeated plasma exchange/exchange transfusion (PE/ET) (Number of times);

⁴ Additional surgery for the complications (POD).

Table 2 Previous series and case reports with TMA after liver transplantation

Year	The firstauthor	Patientnumber	PEtherapy	Focus	Diagnostic advices	Therapeutic advices
2008	Oya	1	+	The risk factor TMA, the relation of TMA and ABO compatibility	-	Reduction of CNI PE Intravenous infusion of high-dose γ-globulin
2007	Miyata	4	+	Plasminogen activator inhibitor type 1, the relation of TMA and ABO compatibility, early diagnosis of TMA for appropriate therapy	Plasminogen activator inhibitor type 1 the vWF value	Early recognition of TMA
2007	Akamatsu	1	+	The reation of TMA and CNI	-	CNI conversion
2006	Nishi	18	+	Poor outcome of TMA recipients PE therapy for TMA, the risk factors of TMA after LDLT	-	PE was not sufficient
2005	Banno	5	+	The analyzer of red blood cell fragmentation	Red blood cell fragmentation	-
2005	Taura	10	+	The relation of TMA and HCV infection		PE CNI conversion
2003	Nakazawa	1	+	The vWF-cleaving protease, the inhibitors against this protease	The vWF-cleaving protease, the inhibitors against this protease	PE
2003	Ramasubbu	1	+	The relation of TMA and CMV	-	-

PE: Plasma exchange; TMA:Thrombotic microangiopathy; CNI: Calcineurin inhibitor; LDLT: Living-donor liver transplantation; HCV: Hepatitis C virus; vWF: von Willebrand factor; CMV: Cytomegalovirus.