Use of argatroban in donor lung procurement: A case report

Abstract

Objective: Unusual setting of medical care Background: Heparin-induced thrombocytopenia (HIT) is an immunological response to heparin exposure that predispos-es patients to hypercoagulable reactions with subsequent heparin administration. Traditionally, heparin is the standard anticoagulant used during organ procurement to prevent clot formation in grafts. This creates a prob-lem in donors or recipients that develop HIT as they are at risk of developing life-threatening coagulopathy. This raises the question of how to use alternative anticoagulation therapies, such as argatroban, that provide rap-id-onset prophylaxis by reversibly inhibiting thrombin. Additionally, there are few studies that have assessed how recipients of multiorgan donors treated with argatroban do post-operatively. Case Report: In this report, we discuss the procurement protocol and hospital course of a lung transplant recipient who received a graft treated with argatroban due to a HIT-positive liver recipient. The post-operative course for our patient was uneventful, with improved lung function and no complications attributable to argatroban use. Further, none of the 4 other recipients who received organs from the same donor experienced graft dysfunc-tions secondary to coagulopathy, including the HIT-positive liver recipient. Conclusions: The ultimate success of grafts without thromboembolic complications suggests the use of argatroban in multi-organ procurement in the setting of a HIT-positive recipient is safe and effective. This case report highlights an alternative to the traditional process of organ procurement with heparin, in which patients at risk of coagulop-athies secondary to HIT are able to receive organs when traditional protocols would otherwise be prohibitive.