Successful treatment of severe transplant-mediated alloimmune thrombocytopenia with early multiple plasmapheresis and thrombopoietin: a case report and a review of the literature

Abstract

Abstract Till date, there is no standard treatment protocol for transplant-mediated alloimmune thrombocytopenia (TMAT). Herein, we report a case of TMAT successfully treated with repeated plasmapheresis and thrombopoietin in the early post-operative period of liver transplantation, and review previously published cases. The liver donor had died of intracranial and multiple organ hemorrhage due to immune thrombocytopenic purpura. Post transplantation, the recipient’s platelet count decreased to 2 x 109/L on postoperative day 1, and anti-platelet antibodies seroconverted from negative to positive. Due to the lack of response to drug treatment, three doses of plasmapheresis in conjunction with thrombopoietin therapy were administered in the early stages of conventional drug treatment. Anti-platelet antibodies reverted to negative, and the platelet count returned to a stable level within a few days. Therefore, for severely refractory transplantation-mediated alloimmune thrombocytopenia, early repeated plasmapheresis combined with thrombopoietin therapy should be considered if there is no rapid response to drug treatment and seroconversion of anti-platelet antibodies occurs from negative to positive.