Liver transplant is a life-saving procedure in patients with end-stage liver disease. However, this procedure may be associated with transmission of various deficiencies of proteins synthesized by the liver. Factor I (fibrinogen) deficiency is one of the rare inherited coagulation disorders with an extremely low risk of transmission by liver transplant. We report a case of a patient with no inherited coagulation disorders but who demonstrated disturbance of fibrinogen after liver transplant. This case highlights the ever-present risk of donor-to-recipient disease transmission during transplant and emphasizes the difficulty in procuring organs from donors in which standard blood tests are insufficient to determine the likelihood of this event. Key words: Blood coagulation disorders, Fibrinogen, Inherited transmission IntroductionThe liver donor was a 34-year-old nullipara woman who was declared brain dead after spontaneous intracranial hemorrhage. Her past medical history was mainly unknown. The donor's laboratory tests on admission showed prothrombin time of 17.3 seconds (normal range, 11-13 s), internationalized normalized ratio (INR) of 1.62, activated partial thromboplastin time of 32 seconds, and a normal platelet count, hemoglobin, and other routine tests. Ultrasonographic examination of the donor's abdomen before organ procurement showed liver having normal parenchymal echogenicity without pathologic lesions. In addition, the donor's pretransplant biopsy did not reveal any pathologic findings, such as marked steatohepatitis, fibrosis, necrosis, or malignancy. Figure 1 shows histology of the liver taken by needle biopsy on the day of organ procurement.The recipient was a 56-year-old man with endstage liver disease secondary to hepatitis B. Model for End-Stage Liver Disease score was 29. Neither he nor his family reported a history of bleeding disorders. The patient underwent deceased-donor liver transplant in November 2014. Duration of the procedure was 6 hours, with total cold ischemic time of 189 minutes and total warm ischemic time of 52 minutes. There was no unusual bleeding during the operation. The total blood loss was 3.6 L. The patient

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Introduction: Inflammatory events after brain death (BD) generally influence the quality of donated organs and adversely affect the outcome of transplant surgeries. Vitamin C is a natural organic compound with potent antioxidant properties. Changes in serum levels of vitamin C (ascorbic acid) following BD are still unknown. Objectives: This study aimed to assess the changes in serum vitamin C levels in brain dead donors in the time elapsed between BD diagnosis and at once before procurement procedure of donated organs. Patients and Methods: In this experimental study, serum vitamin C levels were measured in 37 brain-dead donors (BDDs) at two time points, primarily on admission (R1) and just before organ procurement (R2). The difference between mean values of R1-R2 was analyzed according to the parameters of brain dead donor’s, which consisted of gender, cause of BD, and type of blood group. Results: A total of 37 BDDs (62.2% male) with a mean age of 26.48±18.1 years were included. Time interval between the two samplings was 40.09±12.10 hours. Overall, there was a statistically significant difference between serum ascorbic acid (AA) levels at admission (R1) and immediately before organ procurement (R2) (P=0.016). However, in terms of the cause of BD and blood type, no significant difference in serum AA at the two-time points was detected (P=0.85 and P=0.79 respectively). Conclusion: Significant differences were observed between serum vitamin C levels in the duration between BD diagnosis and immediately before procurement surgery. Therefore, determining the most effective dose of vitamin C supplementation and the best time to administer it to the patients is highly recommended for future studies.

The number of patients who are undergoing liver transplantation is increasing as well as their quality of life and chance for pregnancy. In numerous articles the effect of pregnancy on solid organ transplant recipients has previously been described. In this study a 35-year-old woman (gravida2, para 1) with a history of cryptogenic cirrhosis underwent liver transplantation. She had an uncomplicated postoperative course and was clinically stable on tacrolimus (level 7.9ng/mL) and prednisolone with no episodes of allograft rejection since transplant. Approximately 8months after the operation, she became pregnant. Throughout the pregnancy, the transplant team as well as a perinatologist and obstetrician with a special interest in high-risk pregnancy closely followed her progress. Within this period no deterioration in graft functions or maternal and fetal complications were observed. She experienced an uncomplicated pregnancy. At 38weeks of pregnancy, she delivered a healthy infant who had APGAR scores of seven and nine at five and ten minutes, respectively. Birth weight was 2.86kg, which was appropriate for gestational age. At eight month follow up the infant shows normal development, and there has been no deterioration in the grafts' function. This article shows that pregnancy appears to be safe following liver transplantation, but careful monitoring and pharmacotherapy are pivotal.