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2016 ; 6
(1
): 165-73
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Heparin-induced thrombocytopenia in solid organ transplant recipients: The
current scientific knowledge
#MMPMID27011914
Assfalg V
; Hüser N
World J Transplant
2016[Mar]; 6
(1
): 165-73
PMID27011914
show ga
Exposure to heparin is associated with a high incidence of immunization against
platelet factor 4 (PF4)/heparin complexes. A subgroup of immunized patients is at
risk of developing heparin-induced thrombocytopenia (HIT), an immune mediated
prothrombotic adverse drug effect. Transplant recipients are frequently exposed
to heparin either due to the underlying end-stage disease, which leads to listing
and transplantation or during the transplant procedure and the perioperative
period. To review the current scientific knowledge on anti-heparin/PF4 antibodies
and HIT in transplant recipients a systematic PubMed literature search on
articles in English language was performed. The definition of HIT is inconsistent
amongst the publications. Overall, six studies and 15 case reports have been
published on HIT before or after heart, liver, kidney, and lung transplantation,
respectively. The frequency of seroconversion for anti-PF4/heparin antibodies
ranged between 1.9% and 57.9%. However, different methods to detect
anti-PF4/heparin antibodies were applied. In none of the studies HIT-associated
thromboembolic events or fatalities were observed. More importantly, in patients
with a history of HIT, reexposure to heparin during transplantation was not
associated with thrombotic complications. Taken together, the overall incidence
of HIT after solid organ transplantation seems to be very low. However, according
to the current knowledge, cardiac transplant recipients may have the highest risk
to develop HIT. Different alternative suggestions for heparin-free
anticoagulation have been reported for recipients with suspected HIT albeit no
official recommendations on management have been published for this special
collective so far.