Abdullah A, Hilmi IA, Planinsic R. Diagnostic dilemma of coagulation problems in an HIV-positive patient with end-stage liver disease undergoing liver transplantation. World J Transplant 2015; 5(1): 34-37 [PMID: 25815270 DOI: 10.5500/wjt.v5.i1.34]
Corresponding Author of This Article
Ibtesam A Hilmi, MBCHB, FRCA, Associate Professor, Director of QI/QA, Department of Anesthesiology, Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop St, Pittsburgh, PA 15213, United States. hilmiia@anes.upmc.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Mar 24, 2015; 5(1): 34-37 Published online Mar 24, 2015. doi: 10.5500/wjt.v5.i1.34
Diagnostic dilemma of coagulation problems in an HIV-positive patient with end-stage liver disease undergoing liver transplantation
Ali Abdullah, Ibtesam A Hilmi, Raymond Planinsic
Ali Abdullah, Department of Anesthesiology and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, United States
Ibtesam A Hilmi, Department of Anesthesiology, Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, Pittsburgh, PA 15213, United States
Raymond Planinsic, Department of Anesthesiology, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, Pittsburgh, PA 15213, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: All authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ibtesam A Hilmi, MBCHB, FRCA, Associate Professor, Director of QI/QA, Department of Anesthesiology, Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop St, Pittsburgh, PA 15213, United States. hilmiia@anes.upmc.edu
Telephone: +1-412-6473262 Fax: +1-412-6479260
Received: March 14, 2014 Peer-review started: March 14, 2014 First decision: April 18, 2014 Revised: December 2, 2014 Accepted: December 29, 2014 Article in press: December 31, 2014 Published online: March 24, 2015
Abstract
Human immunodeficiency virus (HIV) may result in devastating multi-organ complications, including cirrhosis. Consequently, liver transplantation is often required for these patients. We report a case of a 43-year-old female with cryptogenic cirrhosis and HIV on highly active antiretroviral therapy, presenting for non-related living donor liver transplantation. The intra-operative course was complicated by hepatic artery and portal vein thrombosis, requiring thrombectomy. On postoperative day-3, the patient required re-transplantation with a cadaveric donor organ due to primary graft failure.
Core tip: Liver transplantation is a technically complicated procedure associated with both predictable and unpredictable coagulation abnormalities. The surgeons are more concerned about bleeding than thrombotic complications in cirrhotic patients undergoing liver transplant, but the reality these patients are equally at risk of both complications. The risk of a thrombotic event is even higher in human immunodeficiency virus (HIV) patients on highly active antiretroviral therapy (HAART) both during and after the surgical procedure. This fact should be ranked high in the differential diagnosis of liver allograft failure in liver transplant recipients who are HIV positive and receiving HAART.
