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KMID : 0882420220970050328
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Korean Journal of Medicine
2022 Volume.97 No. 5 p.328 ~ p.333
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Successful Living Donor Kidney Transplantation in a Patient with MTHFR Deficiency and Heparin-Induced Thrombocytopenia: A Case Report
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Kang Dong-Hyuk
Lee Han-Bi
Chung Byung-Ha
Choi Bum-Soon
Yang Chul-Woo
Ko Eun-Jeong
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Abstract
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Perioperative anticoagulation in a kidney transplant recipient with heparin-induced thrombocytopenia is challenging due to paradoxical hypercoagulability. A 49-year-old man with end-stage kidney disease and a previous stroke history was referred for living donor kidney transplantation. After the fifth dialysis session, the platelet count decreased to 10,000/μL, and heparin was immediately discontinued. Five days later, pulmonary thromboembolism with deep vein thrombosis was identified. Anti-heparin PF4 antibody, elevated serum homocysteine, and methylenetetrahydrofolate reductase gene mutations were discovered. Subsequent coronary angiography revealed three-vessel disease. Apixaban, folate, aspirin, and clopidogrel were administered and an inferior vena cava filter was implanted. Thereafter, coronary artery bypass graft surgery was performed using argatroban-bridging without complications. Kidney transplantation was performed 3 months later using the argatroban protocol. The graft kidney functioned well without any complications. In conclusion, we successfully conducted kidney transplantation in a thrombophilic patient with a methylenetetrahydrofolate reductase deficiency and heparin-induced thrombocytopenia by establishing an individualized perioperative anticoagulation protocol.
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KEYWORD
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Kidney transplantation, Thrombocytopenia, Methylenetetrahydrofolate reductase deficiency, Argatroban
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