TY - JOUR
T1 - Decreased ADAMTS13 Levels in Patients after Living Donor Liver Transplantation
AU - Kobayashi, Toshihiko
AU - Wada, Hideo
AU - Usui, Masanobu
AU - Sakurai, Hiroyuki
AU - Matsumoto, Takeshi
AU - Nobori, Tsutomu
AU - Katayama, Naoyuki
AU - Uemoto, Sinji
AU - Ishizashi, Hiromichi
AU - Matsumoto, Masanori
AU - Fujimura, Yoshihiro
AU - Isaji, Shuji
N1 - Funding Information:
This work was supported in part by Grant-in-Aid for Blood Coagulation Abnormalities from Ministry Health, Labor and Welfare of Japan.
PY - 2009/11
Y1 - 2009/11
N2 - Introduction: Thrombotic microangiopathy (TMA) is a complication occurring after liver transplantation (LT), and an unusually large multimer (ULM) of Von Willebrand factor (VWF) and ADAMTS13 may play an important role in the onset of TMA during LT. Material and Methods: Eight-one patients underwent living donor LT (LDLT). Seventeen of those patients had both severe thrombocytopenia and hemolytic anemia with fragmented red cells and were diagnosed as TMA- like syndrome (TMALS). Results and Conclusions: A significant reduction of ADAMTS13 and an increase of VWF were observed in the patients with TMALS. The ADAMTS13 activity in patients after LDLT was significantly reduced from day 1 to day 21, and it was significantly low in those with TMALS at day 14 and 28. The VWF levels in patients with LDLT were significantly high, and the VWF/ADAMTS13 ratio was significantly increased in patients at 7, 14 and 28 days after LDLT, especially in patients with TMALS at day 14 and 28 after LDLT. High molecular weight multimers of VWF were observed to have increased in patients with LDLT, and the high molecular weight multimers of VWF were further increased in those with mild TMALS but they decreased in those with severe TMA. These findings suggest that ULM- VWF and ADAMTS13 might be associated with the onset of TMA after LT.
AB - Introduction: Thrombotic microangiopathy (TMA) is a complication occurring after liver transplantation (LT), and an unusually large multimer (ULM) of Von Willebrand factor (VWF) and ADAMTS13 may play an important role in the onset of TMA during LT. Material and Methods: Eight-one patients underwent living donor LT (LDLT). Seventeen of those patients had both severe thrombocytopenia and hemolytic anemia with fragmented red cells and were diagnosed as TMA- like syndrome (TMALS). Results and Conclusions: A significant reduction of ADAMTS13 and an increase of VWF were observed in the patients with TMALS. The ADAMTS13 activity in patients after LDLT was significantly reduced from day 1 to day 21, and it was significantly low in those with TMALS at day 14 and 28. The VWF levels in patients with LDLT were significantly high, and the VWF/ADAMTS13 ratio was significantly increased in patients at 7, 14 and 28 days after LDLT, especially in patients with TMALS at day 14 and 28 after LDLT. High molecular weight multimers of VWF were observed to have increased in patients with LDLT, and the high molecular weight multimers of VWF were further increased in those with mild TMALS but they decreased in those with severe TMA. These findings suggest that ULM- VWF and ADAMTS13 might be associated with the onset of TMA after LT.
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U2 - 10.1016/j.thromres.2009.03.010
DO - 10.1016/j.thromres.2009.03.010
M3 - Article
C2 - 19423151
AN - SCOPUS:70349859910
SN - 0049-3848
VL - 124
SP - 541
EP - 545
JO - Thrombosis Research
JF - Thrombosis Research
IS - 5
ER -