Anaphylaxis to aminocaproic acid in the setting of liver transplantation

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.