Successful living donor liver transplantation in a patient with hemophilia A and factor VIII inhibitor: A case report with perioperative recommendations

Reed W Kamyszek; Suman L Sood; Christopher J Sonnenday; Neehar D Parikh; Amanda Westman; Michael J Englesbe; Seth A Waits; Meredith Barrett; Robert J Fontana; Sathish S Kumar

doi:10.1016/j.ajt.2023.02.026

Successful living donor liver transplantation in a patient with hemophilia A and factor VIII inhibitor: A case report with perioperative recommendations

Am J Transplant. 2023 Jun;23(6):839-843. doi: 10.1016/j.ajt.2023.02.026. Epub 2023 Mar 9.

Affiliations

¹ Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA.
² Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
³ Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.
⁴ Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA; Anesthesia Practice Consultants, P.C. Grand Rapids, Michigan, USA.
⁵ Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA. Electronic address: [email protected].

PMID: 36898636
DOI: 10.1016/j.ajt.2023.02.026

Abstract

Liver transplantation in patients with end-stage liver disease and coexisting hemophilia A has been described. Controversy exists over perioperative management of patients with factor VIII inhibitor predisposing patients to hemorrhage. We describe the case of a 58-year-old man with a history of hemophilia A and factor VIII inhibitor, eradicated with rituximab prior to living donor liver transplantation without recurrence of inhibitor. We also provide perioperative management recommendations from our successful multidisciplinary approach.

Keywords: factor inhibitor; hemophilia; living donor liver transplant; remission.

Publication types

Case Reports

MeSH terms

Factor VIII / therapeutic use
Hemophilia A* / complications
Hemophilia A* / surgery
Humans
Liver Transplantation* / adverse effects
Living Donors
Male
Middle Aged
Rituximab

Substances

Factor VIII
Rituximab