{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T20:28:55Z","timestamp":1767990535640,"version":"3.49.0"},"reference-count":17,"publisher":"BMJ","issue":"12","funder":[{"name":"Dedman Scholar of Clinical Care at UT-Southwestern"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,23]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Aminocaproic acid is used to treat hyperfibrinolysis during complex surgery with coagulopathy. We present the first documented case of intraoperative anaphylaxis to aminocaproic acid during liver transplantation. A female in her 50s with hepatitis C-associated and alcohol-associated cirrhosis underwent liver transplantation with a right trisectionectomy allograft. After portal and arterial reperfusion, aminocaproic acid was administered for hyperfibrinolysis. She experienced intraoperative hypotension, hypoxaemia and elevated peak inspiratory pressures. Epinephrine was administered with improvement in haemodynamics and ventilation. Tryptase was elevated after administration of aminocaproic acid and resolved to normal baseline levels which suggested an anaphylaxis to this medication while under anaesthesia. She was extubated post-op day (POD) 1 and was discharged home POD 4. Aminocaproic acid during liver transplantation may cause anaphylactic shock. Haemodynamic and ventilatory changes after administration warrant consideration for empiric treatment and measurement of tryptase levels while other potential aetiologies are also being assessed.<\/jats:p>","DOI":"10.1136\/bcr-2025-265714","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T11:20:53Z","timestamp":1764847253000},"page":"e265714","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Anaphylaxis to aminocaproic acid in the setting of liver transplantation"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5506-8772","authenticated-orcid":false,"given":"Andrew D","family":"Shubin","sequence":"first","affiliation":[{"name":"Division of Surgical Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaffer M","family":"Odeh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Whitney A","family":"Salinas","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parsia A","family":"Vagefi","sequence":"additional","affiliation":[{"name":"Division of Surgical Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhukar S","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Surgical Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"2025120403204813000_18.12.e265714.1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1966.01320190073016"},{"key":"2025120403204813000_18.12.e265714.2","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1097\/00000542-198706000-00010","article-title":"Epsilon-aminocaproic acid for treatment of fibrinolysis during liver transplantation","volume":"66","author":"Kang","year":"1987","journal-title":"Anesthesiology"},{"key":"2025120403204813000_18.12.e265714.3","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1997.01100160276001"},{"key":"2025120403204813000_18.12.e265714.4","first-page":"7978","article-title":"Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials","volume":"8","author":"Lu","year":"2015","journal-title":"Int J Clin Exp Pathol"},{"key":"2025120403204813000_18.12.e265714.5","doi-asserted-by":"crossref","DOI":"10.1177\/10760296221114862","article-title":"Is Antifibrinolytic Therapy Effective for Preventing Hemorrhage in Patients with Hemophilia Undergoing Dental Extractions? A Systematic Review and Meta-Analysis","volume":"28","author":"Ullah","year":"2022","journal-title":"Clin Appl Thromb Hemost"},{"key":"2025120403204813000_18.12.e265714.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.02730.x"},{"key":"2025120403204813000_18.12.e265714.7","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200007000-00006"},{"key":"2025120403204813000_18.12.e265714.8","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1080\/10428194.2018.1434882","article-title":"Thromboembolic complications following aminocaproic acid use in patients with hematologic malignancies","volume":"59","author":"Juhl","year":"2018","journal-title":"Leuk Lymphoma"},{"key":"2025120403204813000_18.12.e265714.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1978.03290220080026"},{"key":"2025120403204813000_18.12.e265714.10","doi-asserted-by":"publisher","DOI":"10.3109\/15563657909030118"},{"key":"2025120403204813000_18.12.e265714.11","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.transproceed.2014.04.006","article-title":"Aminocaproic Acid (amicar) as an alternative to aprotinin (trasylol) in liver transplantation","volume":"46","author":"Mangus","year":"2014","journal-title":"Transplant Proc"},{"key":"2025120403204813000_18.12.e265714.12","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1053\/j.jvca.2015.12.003","article-title":"Epsilon-Aminocaproic Acid Has No Association With Thromboembolic Complications, Renal Failure, or Mortality After Liver Transplantation","volume":"30","author":"Nicolau-Raducu","year":"2016","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025120403204813000_18.12.e265714.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.281.6234.197-a"},{"key":"2025120403204813000_18.12.e265714.14","first-page":"415","article-title":"Suspected anaphylactoid shock to aminocaproic acid (plaslloid) during operation","volume":"50","author":"Yien","year":"1992","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"2025120403204813000_18.12.e265714.15","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1097\/TP.0000000000003642","article-title":"Hemodynamic Instability During Liver Transplantation in Patients With End-stage Liver Disease: A Consensus Document from ILTS, LICAGE, and SATA","volume":"105","author":"Bezinover","year":"2021","journal-title":"Transplantation"},{"key":"2025120403204813000_18.12.e265714.16","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1007\/s12016-020-08777-7","article-title":"Using Baseline and Peak Serum Tryptase Levels to Diagnose Anaphylaxis: a Review","volume":"58","author":"Passia","year":"2020","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025120403204813000_18.12.e265714.17","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/all.15032","article-title":"EAACI guidelines: Anaphylaxis (2021 update)","volume":"77","author":"Muraro","year":"2022","journal-title":"Allergy"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-265714","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T11:20:54Z","timestamp":1764847254000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-265714"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":17,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,4]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bcr-2025-265714"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-265714","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}