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World J Transplant. Mar 24, 2016; 6(1): 165-173
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.165
Heparin-induced thrombocytopenia in solid organ transplant recipients: The current scientific knowledge
Volker Assfalg, Norbert Hüser
Volker Assfalg, Norbert Hüser, Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany
Author contributions: Both authors equally contributed to this paper with conception and design of the review, literature review and analysis, drafting and critical revision and editing and final approval of the final version.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Volker Assfalg, MD, Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, D-81675 Munich, Germany. volker.assfalg@tum.de
Telephone: +49-89-41402121 Fax: +49-89-41404870
Received: August 28, 2015
Peer-review started: August 31, 2015
First decision: November 24, 2015
Revised: December 18, 2015
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: March 24, 2016
Abstract

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.

Keywords: Heparin-induced thrombocytopenia, Heparin-induced thrombocytopenia, Heparin, Organ, Transplantation

Core tip: Heparin-induced thrombocytopenia (HIT) II is a life-threatening complication of heparin therapy. Transplant recipients frequently are exposed to high doses of heparin before, during, and after transplantation. This review gives a systematic overview on the current scientific knowledge and existing publications on anti-platelet factor 4/heparin antibodies and HIT in transplant candidates and recipients.