THE WHITE CLOT SYNDROME IN HEPATIC TRANSPLANTATION

Heparin-associated thrombocytopenia and thrombosis (Type II HAT), the ''white clot syndrome,'' has not been previously reported as a cause f or fulminant hepatic failure after liver transplantation. Thrombocytop enia and the use of heparin are common events in the newly transplante d patient. A man who was transplanted for sclerosing cholangitis, and re-exposed to heparin, is described with thrombocytopenia, thrombosis of all hepatic vessels, and heparin antibodies. Type II HAT is an immu ne phenomenon that can apparently occur despite T-cell-directed immuno suppression. Suspicion is a key element in establishing diagnosis. We no longer use heparin routinely in liver transplant cases.