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Objective: Thrombocytopenia secondary to idiopathic thrombocytopenia purpura (ITP) resulting in intracranial hemorrhage and death is a source of potential liver allografts for transplantation (LTX). Transmission of donorderived anti-platelet antibody resulting in recipient thrombocytopenia is termed Transplantation-Mediated Alloimmune Thrombocytopenia (TMAT). To date, no clear consensus has emerged on the appropriateness of these organs for transplantation. Our objective is to report a case of TMAT within the context of a 5 patient series we have obtained and provide an algorithm for the safe utilization of ITP donors based upon the current literature. Methods: Case report and review of a 5 patient clinical series from 2003 to 2016. Results: An ITP donor (platelet count 2000/ml) was transplanted in a critically ill recipient (intensive care unit, MELD 33) who developed TMAT, as evidenced by thrombocytopenia (platelet count < 10,000/ml) and detection of serum anti-platelet antibody for glycoprotein IIb/ IIIa, Ib/IX, and Ia/IIa antibodies. A heparin-induced thrombocytopenia assay was negative. Within 5 days post-LTX, the patient experienced thrombocytopenia, petechiae, and a small area of cerebral parenchymal hemorrhage on CT scan but was successfully treated with corticosteroids, gamma-globulin, basiliximab, and judicious platelet transfusion with resolution of thrombocytopenia and clearance of anti-platelet antibody within 21 days of LTX. A clonal origin, rather than passive antibody transfer, was suggested by early anti-platelet antibody screenings that were negative pre-LTX and immediately post-LTX. These results were expected based upon our clinical series. Conclusion: ITP donors can be used for LTX. We have developed a clinical algorithm, based upon the donor's response to therapy, that predicts post-LTX success.

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