Korean J Med.  2022 Oct;97(5):328-333. 10.3904/kjm.2022.97.5.328.

Successful Living Donor Kidney Transplantation in a Patient with MTHFR Deficiency and Heparin-Induced Thrombocytopenia: A Case Report

• Kang D
• Lee H
• Chung BH
• Choi BS
• Yang CW
• Ko EJ

• KMID: 2534388
• DOI: http://doi.org/10.3904/kjm.2022.97.5.328

Abstract

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.

Keyword

신장 이식; 혈소판감소증; 메틸렌사수소엽산 환원효소 결핍증; 아가트로반; Kidney transplantation; Thrombocytopenia; Methylenetetrahydrofolate reductase deficiency; Argatroban