Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature
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摘要
BACKGROUND Cytomegalovirus(CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia(AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation(LDLT).CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy(GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE.CONCLUSION This case report suggests a monitoring method that could be useful for AGnegative CMV gastroenteritis after a solid-organ transplantation.
BACKGROUND Cytomegalovirus(CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia(AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation(LDLT).CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy(GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE.CONCLUSION This case report suggests a monitoring method that could be useful for AGnegative CMV gastroenteritis after a solid-organ transplantation.
BACKGROUND Cytomegalovirus(CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia(AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation(LDLT).CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy(GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE.CONCLUSION This case report suggests a monitoring method that could be useful for AGnegative CMV gastroenteritis after a solid-organ transplantation.
引文
1 Mori T,Mori S,Kanda Y,Yakushiji K,Mineishi S,Takaue Y,Gondo H,Harada M,Sakamaki H,Yajima T,Iwao Y,Hibi T,Okamoto S.Clinical significance of cytomegalovirus(CMV)antigenemia in the prediction and diagnosis of CMV gastrointestinal disease after allogeneic hematopoietic stem cell transplantation.Bone Marrow Transplant 2004;33:431-434[PMID:14676775 DOI:10.1038/sj.bmt.1704369]
2 Ozaki T,Yamashita H,Kaneko S,Yorifuji H,Takahashi H,Ueda Y,Takahashi Y,Kaneko H,Kano T,Mimori A.Cytomegalovirus disease of the upper gastrointestinal tract in patients with rheumatic diseases:a case series and literature review.Clin Rheumatol 2013;32:1683-1690[PMID:23942768 DOI:10.1007/s10067-013-2363-7]
3 Vincenzi R,Fonseca EA,Chapchap P,Machado MCC,Roda KMO,Candido HL,Benavides MR,D'Assuncao MA,Afonso RC,Turine P,Marson FP,Neto JS.Pancreas-preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease.Pediatr Transplant 2017;21[PMID:28881059 DOI:10.1111/petr.13059]
4 Hibi T,Tanabe M,Hoshino K,Fuchimoto Y,Kawachi S,Itano O,Obara H,Shinoda M,Shimojima N,Matsubara K,Morikawa Y,Kitagawa Y.Cyclosporine A-based immunotherapy in adult living donor liver transplantation:accurate and improved therapeutic drug monitoring by 4-hr intravenous infusion.Transplantation 2011;92:100-105[PMID:21546866 DOI:10.1097/TP.0b013e31821dcae3]
5 Hibi T,Shinoda M,Itano O,Obara H,Kitago M,Abe Y,Yagi H,Tanaka M,Hoshino K,Fujino A,Kuroda T,Kawachi S,Tanabe M,Shimazu M,Kitagawa Y.Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis.Hepatol Res 2015;45:1178-1184[PMID:25594837 DOI:10.1111/hepr.12486]
6 Azevedo LS,Pierrotti LC,Abdala E,Costa SF,Strabelli TM,Campos SV,Ramos JF,Latif AZ,Litvinov N,Maluf NZ,Caiaffa Filho HH,Pannuti CS,Lopes MH,Santos VA,Linardi Cda C,Yasuda MA,Marques HH.Cytomegalovirus infection in transplant recipients.Clinics(Sao Paulo)2015;70:515-523[PMID:26222822 DOI:10.6061/clinics/2015(07)09]
7 Kotton CN,Kumar D,Caliendo AM,Asberg A,Chou S,Snydman DR,Allen U,Humar A;Transplantation Society International CMV Consensus Group.International consensus guidelines on the management of cytomegalovirus in solid organ transplantation.Transplantation 2010;89:779-795[PMID:20224515 DOI:10.1097/TP.0b013e3181cee42f]
8 Boeckh M,Bowden RA,Goodrich JM,Pettinger M,Meyers JD.Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation.Blood 1992;80:1358-1364[PMID:1325214]
9 David-Neto E,Triboni AH,Paula FJ,Vilas Boas LS,Machado CM,Agena F,Latif AZ,Alencar CS,Pierrotti LC,Nahas WC,Caiaffa-Filho HH,Pannuti CS.A double-blinded,prospective study to define antigenemia and quantitative real-time polymerase chain reaction cutoffs to start preemptive therapy in low-risk,seropositive,renal transplanted recipients.Transplantation 2014;98:1077-1081[PMID:24839894 DOI:10.1097/TP.0000000000000189]
10 Nagata N,Kobayakawa M,Shimbo T,Hoshimoto K,Yada T,Gotoda T,Akiyama J,Oka S,Uemura N.Diagnostic value of antigenemia assay for cytomegalovirus gastrointestinal disease in immunocompromised patients.World J Gastroenterol 2011;17:1185-1191[PMID:21448424 DOI:10.3748/wjg.v17.i9.1185]
11 Boaretti M,Sorrentino A,Zantedeschi C,Forni A,Boschiero L,Fontana R.Quantification of cytomegalovirus DNA by a fully automated real-time PCR for early diagnosis and monitoring of active viral infection in solid organ transplant recipients.J Clin Virol 2013;56:124-128[PMID:23182772 DOI:10.1016/j.jcv.2012.10.015]
12 Kwon S,Jung BK,Ko SY,Lee CK,Cho Y.Comparison of quantitation of cytomegalovirus DNA by realtime PCR in whole blood with the cytomegalovirus antigenemia assay.Ann Lab Med 2015;35:99-104[PMID:25553288 DOI:10.3343/alm.2015.35.1.99]
13 Dahi PB,Perales MA,Devlin SM,Olson A,Lubin M,Gonzales AM,Scaradavou A,Kernan NA,O'Reilly RJ,Giralt S,Jakubowski A,Koehne G,Papadopoulos EB,Ponce DM,Sauter C,Papanicolaou G,Barker JN.Incidence,nature and mortality of cytomegalovirus infection after double-unit cord blood transplant.Leuk Lymphoma 2015;56:1799-1805[PMID:25224458 DOI:10.3109/10428194.2014.963079]
14 Mori T,Okamoto S,Matsuoka S,Yajima T,Wakui M,Watanabe R,Ishida A,Iwao Y,Mukai M,Hibi T,Ikeda Y.Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation.Bone Marrow Transplant 2000;25:765-769[PMID:10745263 DOI:10.1038/sj.bmt.1702227]
15 Durand CM,Marr KA,Arnold CA,Tang L,Durand DJ,Avery RK,Valsamakis A,Neofytos D.Detection of cytomegalovirus DNA in plasma as an adjunct diagnostic for gastrointestinal tract disease in kidney and liver transplant recipients.Clin Infect Dis 2013;57:1550-1559[PMID:23956167 DOI:10.1093/cid/cit521]
16 Boeckh M,Ljungman P.How we treat cytomegalovirus in hematopoietic cell transplant recipients.Blood2009;113:5711-5719[PMID:19299333 DOI:10.1182/blood-2008-10-143560]
17 Seo M,Kim do H,Gong EJ,Ahn JY,Lee JH,Jung KW,Choi KD,Song HJ,Lee GH,Jung HY,Kim JH,Lee SO,Choi SH,Kim YS,Woo JH,Kim SH.Is Follow-Up Endoscopy Necessary in Upper Gastrointestinal Cytomegalovirus Disease?Medicine(Baltimore)2016;95:e3389[PMID:27175637 DOI:10.1097/MD.0000000000003389]
18 Yanada M,Yamamoto K,Emi N,Naoe T,Suzuki R,Taji H,Iida H,Shimokawa T,Kohno A,Mizuta S,Maruyama F,Wakita A,Kitaori K,Yano K,Hamaguchi M,Hamajima N,Morishima Y,Kodera Y,Sao H,Morishita Y.Cytomegalovirus antigenemia and outcome of patients treated with pre-emptive ganciclovir:retrospective analysis of 241 consecutive patients undergoing allogeneic hematopoietic stem cell transplantation.Bone Marrow Transplant 2003;32:801-807[PMID:14520425 DOI:10.1038/sj.bmt.1704232]
19 Mori T,Okamoto S,Watanabe R,Yamazaki R,Tsukada Y,Nagayama H,Ishida A,Ikeda Y.Incidence of cytomegalovirus(CMV)infection in allogeneic hematopoietic stem cell recipients at low risk of CMVinfection.Bone Marrow Transplant 2002;29:1005-1006[PMID:12098071 DOI:10.1038/sj.bmt.1703588]
20 De Bartolomeis C,Collini A,Barni R,Ruggieri G,Bernini M,Carmellini M.Cytomegalovirus infection with multiple colonic perforations in a renal transplant recipient.Transplant Proc 2005;37:2504-2506[PMID:16182726 DOI:10.1016/j.transproceed.2005.06.082]
21 Zandberg M,de Maar EF,Hofker HS,Homan van der Heide JJ,Rosati S,van Son WJ.Initial cytomegalovirus prophylaxis with ganciclovir:no guarantee for prevention of late serious manifestations of CMV after solid organ transplantation.Neth J Med 2005;63:408-412[PMID:16301763]
22 Atsumi H,Asaka M,Kimura S,Imura J,Fujimoto K,Chikazawa Y,Nakagawa M,Okuyama H,Yamaya H,Moriyama M,Tanaka T,Suzuki K,Yokoyama H.A case of second renal transplantation with acute antibody-mediated rejection complicated with BK virus nephropathy.Clin Transplant 2010;24 Suppl 22:35-38[PMID:20590692 DOI:10.1111/j.1399-0012.2010.01280.x]
23 Kemény E,Hirsch HH,Eller J,Dürmüller U,Hopfer H,Mihatsch MJ.Plasma cell infiltrates in polyomavirus nephropathy.Transpl Int 2010;23:397-406[PMID:19912590 DOI:10.1111/j.1432-2277.2009.01001.x]
24 Nakazawa Y,Hashikura Y,Urata K,Ikegami T,Terada M,Yagi H,Ishizashi H,Matsumoto M,Fujimura Y,Miyagawa S.Von Willebrand factor--cleaving protease activity in thrombotic microangiopathy after living donor liver transplantation:a case report.Liver Transpl 2003;9:1328-1333[PMID:14625834 DOI:10.1016/j.lts.2003.09.021]
25 Kobayashi T,Wada H,Usui M,Sakurai H,Matsumoto T,Nobori T,Katayama N,Uemoto S,Ishizashi H,Matsumoto M,Fujimura Y,Isaji S.Decreased ADAMTS13 levels in patients after living donor liver transplantation.Thromb Res 2009;124:541-545[PMID:19423151 DOI:10.1016/j.thromres.2009.03.010]
26 Kishida N,Shinoda M,Itano O,Obara H,Kitago M,Hibi T,Yagi H,Abe Y,Matsubara K,Odaira M,Tanabe M,Shimazu M,Kitagawa Y.Increased Incidence of Thrombotic Microangiopathy After ABO-Incompatible Living Donor Liver Transplantation.Ann Transplant 2016;21:755-764[PMID:27956735DOI:10.12659/AOT.900915]
27 Narimatsu H,Kami M,Hara S,Matsumura T,Miyakoshi S,Kusumi E,Kakugawa Y,Kishi Y,Murashige N,Yuji K,Masuoka K,Yoneyama A,Wake A,Morinaga S,Kanda Y,Taniguchi S.Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation.Bone Marrow Transplant 2005;36:517-523[PMID:16025150 DOI:10.1038/sj.bmt.1705099]
28 Rahbar A,S?derberg-Nauclér C.Human cytomegalovirus infection of endothelial cells triggers platelet adhesion and aggregation.J Virol 2005;79:2211-2220[PMID:15681423 DOI:10.1128/JVI.79.4.2211-2220.2005]
29 Java A,Edwards A,Rossi A,Pandey R,Gaut J,Delos Santos R,Miller B,Klein C,Brennan D.Cytomegalovirus-induced thrombotic microangiopathy after renal transplant successfully treated with eculizumab:case report and review of the literature.Transpl Int 2015;28:1121-1125[PMID:25864519DOI:10.1111/tri.12582]
30 Waiser J,Budde K,Rudolph B,Ortner MA,Neumayer HH.De novo hemolytic uremic syndrome postrenal transplant after cytomegalovirus infection.Am J Kidney Dis 1999;34:556-559[PMID:10469868 DOI:10.1053/AJKD03400556]
2 Ozaki T,Yamashita H,Kaneko S,Yorifuji H,Takahashi H,Ueda Y,Takahashi Y,Kaneko H,Kano T,Mimori A.Cytomegalovirus disease of the upper gastrointestinal tract in patients with rheumatic diseases:a case series and literature review.Clin Rheumatol 2013;32:1683-1690[PMID:23942768 DOI:10.1007/s10067-013-2363-7]
3 Vincenzi R,Fonseca EA,Chapchap P,Machado MCC,Roda KMO,Candido HL,Benavides MR,D'Assuncao MA,Afonso RC,Turine P,Marson FP,Neto JS.Pancreas-preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease.Pediatr Transplant 2017;21[PMID:28881059 DOI:10.1111/petr.13059]
4 Hibi T,Tanabe M,Hoshino K,Fuchimoto Y,Kawachi S,Itano O,Obara H,Shinoda M,Shimojima N,Matsubara K,Morikawa Y,Kitagawa Y.Cyclosporine A-based immunotherapy in adult living donor liver transplantation:accurate and improved therapeutic drug monitoring by 4-hr intravenous infusion.Transplantation 2011;92:100-105[PMID:21546866 DOI:10.1097/TP.0b013e31821dcae3]
5 Hibi T,Shinoda M,Itano O,Obara H,Kitago M,Abe Y,Yagi H,Tanaka M,Hoshino K,Fujino A,Kuroda T,Kawachi S,Tanabe M,Shimazu M,Kitagawa Y.Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis.Hepatol Res 2015;45:1178-1184[PMID:25594837 DOI:10.1111/hepr.12486]
6 Azevedo LS,Pierrotti LC,Abdala E,Costa SF,Strabelli TM,Campos SV,Ramos JF,Latif AZ,Litvinov N,Maluf NZ,Caiaffa Filho HH,Pannuti CS,Lopes MH,Santos VA,Linardi Cda C,Yasuda MA,Marques HH.Cytomegalovirus infection in transplant recipients.Clinics(Sao Paulo)2015;70:515-523[PMID:26222822 DOI:10.6061/clinics/2015(07)09]
7 Kotton CN,Kumar D,Caliendo AM,Asberg A,Chou S,Snydman DR,Allen U,Humar A;Transplantation Society International CMV Consensus Group.International consensus guidelines on the management of cytomegalovirus in solid organ transplantation.Transplantation 2010;89:779-795[PMID:20224515 DOI:10.1097/TP.0b013e3181cee42f]
8 Boeckh M,Bowden RA,Goodrich JM,Pettinger M,Meyers JD.Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation.Blood 1992;80:1358-1364[PMID:1325214]
9 David-Neto E,Triboni AH,Paula FJ,Vilas Boas LS,Machado CM,Agena F,Latif AZ,Alencar CS,Pierrotti LC,Nahas WC,Caiaffa-Filho HH,Pannuti CS.A double-blinded,prospective study to define antigenemia and quantitative real-time polymerase chain reaction cutoffs to start preemptive therapy in low-risk,seropositive,renal transplanted recipients.Transplantation 2014;98:1077-1081[PMID:24839894 DOI:10.1097/TP.0000000000000189]
10 Nagata N,Kobayakawa M,Shimbo T,Hoshimoto K,Yada T,Gotoda T,Akiyama J,Oka S,Uemura N.Diagnostic value of antigenemia assay for cytomegalovirus gastrointestinal disease in immunocompromised patients.World J Gastroenterol 2011;17:1185-1191[PMID:21448424 DOI:10.3748/wjg.v17.i9.1185]
11 Boaretti M,Sorrentino A,Zantedeschi C,Forni A,Boschiero L,Fontana R.Quantification of cytomegalovirus DNA by a fully automated real-time PCR for early diagnosis and monitoring of active viral infection in solid organ transplant recipients.J Clin Virol 2013;56:124-128[PMID:23182772 DOI:10.1016/j.jcv.2012.10.015]
12 Kwon S,Jung BK,Ko SY,Lee CK,Cho Y.Comparison of quantitation of cytomegalovirus DNA by realtime PCR in whole blood with the cytomegalovirus antigenemia assay.Ann Lab Med 2015;35:99-104[PMID:25553288 DOI:10.3343/alm.2015.35.1.99]
13 Dahi PB,Perales MA,Devlin SM,Olson A,Lubin M,Gonzales AM,Scaradavou A,Kernan NA,O'Reilly RJ,Giralt S,Jakubowski A,Koehne G,Papadopoulos EB,Ponce DM,Sauter C,Papanicolaou G,Barker JN.Incidence,nature and mortality of cytomegalovirus infection after double-unit cord blood transplant.Leuk Lymphoma 2015;56:1799-1805[PMID:25224458 DOI:10.3109/10428194.2014.963079]
14 Mori T,Okamoto S,Matsuoka S,Yajima T,Wakui M,Watanabe R,Ishida A,Iwao Y,Mukai M,Hibi T,Ikeda Y.Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation.Bone Marrow Transplant 2000;25:765-769[PMID:10745263 DOI:10.1038/sj.bmt.1702227]
15 Durand CM,Marr KA,Arnold CA,Tang L,Durand DJ,Avery RK,Valsamakis A,Neofytos D.Detection of cytomegalovirus DNA in plasma as an adjunct diagnostic for gastrointestinal tract disease in kidney and liver transplant recipients.Clin Infect Dis 2013;57:1550-1559[PMID:23956167 DOI:10.1093/cid/cit521]
16 Boeckh M,Ljungman P.How we treat cytomegalovirus in hematopoietic cell transplant recipients.Blood2009;113:5711-5719[PMID:19299333 DOI:10.1182/blood-2008-10-143560]
17 Seo M,Kim do H,Gong EJ,Ahn JY,Lee JH,Jung KW,Choi KD,Song HJ,Lee GH,Jung HY,Kim JH,Lee SO,Choi SH,Kim YS,Woo JH,Kim SH.Is Follow-Up Endoscopy Necessary in Upper Gastrointestinal Cytomegalovirus Disease?Medicine(Baltimore)2016;95:e3389[PMID:27175637 DOI:10.1097/MD.0000000000003389]
18 Yanada M,Yamamoto K,Emi N,Naoe T,Suzuki R,Taji H,Iida H,Shimokawa T,Kohno A,Mizuta S,Maruyama F,Wakita A,Kitaori K,Yano K,Hamaguchi M,Hamajima N,Morishima Y,Kodera Y,Sao H,Morishita Y.Cytomegalovirus antigenemia and outcome of patients treated with pre-emptive ganciclovir:retrospective analysis of 241 consecutive patients undergoing allogeneic hematopoietic stem cell transplantation.Bone Marrow Transplant 2003;32:801-807[PMID:14520425 DOI:10.1038/sj.bmt.1704232]
19 Mori T,Okamoto S,Watanabe R,Yamazaki R,Tsukada Y,Nagayama H,Ishida A,Ikeda Y.Incidence of cytomegalovirus(CMV)infection in allogeneic hematopoietic stem cell recipients at low risk of CMVinfection.Bone Marrow Transplant 2002;29:1005-1006[PMID:12098071 DOI:10.1038/sj.bmt.1703588]
20 De Bartolomeis C,Collini A,Barni R,Ruggieri G,Bernini M,Carmellini M.Cytomegalovirus infection with multiple colonic perforations in a renal transplant recipient.Transplant Proc 2005;37:2504-2506[PMID:16182726 DOI:10.1016/j.transproceed.2005.06.082]
21 Zandberg M,de Maar EF,Hofker HS,Homan van der Heide JJ,Rosati S,van Son WJ.Initial cytomegalovirus prophylaxis with ganciclovir:no guarantee for prevention of late serious manifestations of CMV after solid organ transplantation.Neth J Med 2005;63:408-412[PMID:16301763]
22 Atsumi H,Asaka M,Kimura S,Imura J,Fujimoto K,Chikazawa Y,Nakagawa M,Okuyama H,Yamaya H,Moriyama M,Tanaka T,Suzuki K,Yokoyama H.A case of second renal transplantation with acute antibody-mediated rejection complicated with BK virus nephropathy.Clin Transplant 2010;24 Suppl 22:35-38[PMID:20590692 DOI:10.1111/j.1399-0012.2010.01280.x]
23 Kemény E,Hirsch HH,Eller J,Dürmüller U,Hopfer H,Mihatsch MJ.Plasma cell infiltrates in polyomavirus nephropathy.Transpl Int 2010;23:397-406[PMID:19912590 DOI:10.1111/j.1432-2277.2009.01001.x]
24 Nakazawa Y,Hashikura Y,Urata K,Ikegami T,Terada M,Yagi H,Ishizashi H,Matsumoto M,Fujimura Y,Miyagawa S.Von Willebrand factor--cleaving protease activity in thrombotic microangiopathy after living donor liver transplantation:a case report.Liver Transpl 2003;9:1328-1333[PMID:14625834 DOI:10.1016/j.lts.2003.09.021]
25 Kobayashi T,Wada H,Usui M,Sakurai H,Matsumoto T,Nobori T,Katayama N,Uemoto S,Ishizashi H,Matsumoto M,Fujimura Y,Isaji S.Decreased ADAMTS13 levels in patients after living donor liver transplantation.Thromb Res 2009;124:541-545[PMID:19423151 DOI:10.1016/j.thromres.2009.03.010]
26 Kishida N,Shinoda M,Itano O,Obara H,Kitago M,Hibi T,Yagi H,Abe Y,Matsubara K,Odaira M,Tanabe M,Shimazu M,Kitagawa Y.Increased Incidence of Thrombotic Microangiopathy After ABO-Incompatible Living Donor Liver Transplantation.Ann Transplant 2016;21:755-764[PMID:27956735DOI:10.12659/AOT.900915]
27 Narimatsu H,Kami M,Hara S,Matsumura T,Miyakoshi S,Kusumi E,Kakugawa Y,Kishi Y,Murashige N,Yuji K,Masuoka K,Yoneyama A,Wake A,Morinaga S,Kanda Y,Taniguchi S.Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation.Bone Marrow Transplant 2005;36:517-523[PMID:16025150 DOI:10.1038/sj.bmt.1705099]
28 Rahbar A,S?derberg-Nauclér C.Human cytomegalovirus infection of endothelial cells triggers platelet adhesion and aggregation.J Virol 2005;79:2211-2220[PMID:15681423 DOI:10.1128/JVI.79.4.2211-2220.2005]
29 Java A,Edwards A,Rossi A,Pandey R,Gaut J,Delos Santos R,Miller B,Klein C,Brennan D.Cytomegalovirus-induced thrombotic microangiopathy after renal transplant successfully treated with eculizumab:case report and review of the literature.Transpl Int 2015;28:1121-1125[PMID:25864519DOI:10.1111/tri.12582]
30 Waiser J,Budde K,Rudolph B,Ortner MA,Neumayer HH.De novo hemolytic uremic syndrome postrenal transplant after cytomegalovirus infection.Am J Kidney Dis 1999;34:556-559[PMID:10469868 DOI:10.1053/AJKD03400556]