부산대학교 도서관

본 증례는 혈전 발생 위험도가 높은 MTHFR 유전자 변이와 헤파린유도 혈소판 감소증 두 질환을 동시에 가진 말기신부전 환자에서 신장 이식을 진행함에 있어, 수술 전후 혈전증 및 출혈을 최소화하는 개별화된 특수 항응고 치료 프로토콜을 적용하여 특이 합병증 없이 신장이식에 성공한 바, 이에 문헌고찰과 함께 보고하는 바이다.
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. (Korean J Med 2022;97:328-333)