Case Report Liver Transplantation Using Graft From a Donor With Aplastic Anemia Soheila Milani, MD 1 , Mohsen Aliakbarian, MD 1 , and Ebrahim Khaleghi, MD 2 Abstract Liver transplantation (LT) is a life-saving procedure in patients with end-stage liver disease. The number of patients in the waiting list for LT has steadily increased over time, so removing liver from deceased donors with unusual disorders could possibly be used for transplantation. We describe a case of LT from a donor with “aplastic anemia” to a patient with liver failure due to hepatitis C. Aplastic anemia is a syndrome of bone marrow failure. Aplastic anemia is one of the most common conditions linked to transfusion dependence, and long-term repeated transfusion inevitably results in iron overload. Also iron is a cofactor that influences the severity and progression of nonhemochromatic liver diseases, especially steatohepatitis and viral hepatitis. The aim of this report is to highlight the posttransplant findings of the recipient, with specific emphasis on the graft function. Our findings provide insights into the clinical implications of LT using graft with this rare disorder. Keywords liver transplantation, donor, anemia, aplastic, graft Case Report Liver transplantation (LT) is a life-saving procedure in patients with end-stage liver disease (ESLD). The number of patients in the waiting list for a liver transplant has steadily increased over time, so removing liver from deceased donors with unusual disorders could possibly be used for transplantation. We describe a case of transplantation from a donor with “aplastic anemia” (AA) to a patient with liver failure due to hepatitis C. Aplastic anemia is a syndrome of bone marrow failure, linked to transfusion dependence, and long-term repeated transfusion inevitably results in iron overload. Also iron is a cofactor that influences the severity and progression of nonhemochromatic liver diseases, especially steatohepatitis and viral hepatitis. 1 The aim of this report is to highlight the posttransplant findings of the recipient using graft with this rare disorder. The deceased donor was a 14-year-old boy, and the cause of brain death was cerebral hemorrhage secondary to thrombocy- topenia. He had a history of known AA and several blood transfusion from 2 years prior to his death. Laboratory tests “posthumously” showed aspartate aminotransferase (AST) 42 IU/L (normal: up to 40 IU/L), alanine aminotransferase (ALT) 96 IU/L (normal: up to 40 IU/L), serum alkaline phosphatase level 1300 IU/L (normal: 80-306 IU/L in male), and total bilir- ubin 1.46 mg/dL (normal: 0.1-1.5 mg/dL). The donor was given 8 U of packed red blood cells (PRBCs) during his final admission to hospital. The ultrasound report of the donor’s abdomen before organ procurement stated: “The liver span in the midclavicular line was 110 mm and had nor- mal parenchymal echogenicity without pathological lesion.” The donor’s pretransplant biopsy did not reveal any pathologi- cal findings. The recipient was a 60-year-old man with ESLD secondary to hepatitis C genotype l (body mass index ¼ 30; The model for end-stage liver disease (MELD) score ¼ 20). During the transplant operation, he was given 5 U of PRBCs. The patient made an excellent postoperative recovery. A percutaneous liver biopsy was performed on day 120 after LT because of an increase in ALT and AST, and at the same time, quantitative real-time Polymerase chain reaction (PCR) determined hepatitis C virus (HCV) viral load of 3 149 000 copies/mL. The biopsy specimen confirmed grade 5/18, stage 2/6 chronic hepatitis with mild activity and mild fibrosis, sug- gestive of recurrent HCV infection, and grade 3/4 hemochro- matosis. At the same time, the serum ferritin value was >1650 ng/mL (normal: 22-322 ng/mL). Standard treatment of recurrent 1 Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 2 Organ Transplant Center, Mashhad University of Medical Sciences, Montaserieh Hospital, Mashhad, Iran Corresponding Author: Soheila Milani, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Email: drmilanis7@gmail.com Progress in Transplantation 2017, Vol. 27(2) 219-220 ª 2017, NATCO. All rights reserved. Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1526924817699970 journals.sagepub.com/home/pit