Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.99
Peer-review started: October 7, 2018
First decision: October 18, 2018
Revised: December 20, 2018
Accepted: December 31, 2018
Article in press: January 1, 2019
Published online: January 27, 2019
Processing time: 113 Days and 16.1 Hours
The impact of platelets on liver transplantation (LT) is well recognized, but not completely understood. Platelets exert dichotomous effects on the graft and on the patient. On the one hand, they are essential for primary hemostasis and tissue repair and regeneration. On the other hand, they support ischemia/reperfusion injury and inflammatory processes. Recent evidence has shown a new role for platelet count (PC) in predicting outcomes after LT.
To evaluate if low PC is a predictor of short- and long-term outcomes after LT.
Four hundred and eighty consecutive LT patients were retrospectively assessed. PC from the preoperative to the seventh postoperative day (POD) were considered. C-statistic analysis defined the ideal cutoff point for PC. Cox regression was performed to check whether low PC was a predictor of death, retransplantation or primary changes in graft function within one year after LT.
The highest median PC was 86 × 109/L [interquartile range (IQR) = 65–100 × 109/L] on seventh POD, and the lowest was 51 × 109/L (IQR = 38–71 × 109/L) on third POD. The C-statistic defined a PC < 70 × 109/L on fifth POD as the ideal cutoff point for predicting death and retransplantation. In the multivariate analysis, platelets < 70 × 109/L on 5POD was an independent risk factor for death at 12 mo after LT [hazard ratio (HR) = 2.01; 95% confidence interval (CI) 1.06-3.79; P = 0.031]. In the Cox regression, patients with PC < 70 × 109/L on 5POD had worse graft survival rates up to one year after LT (HR = 2.76; 95%CI 1.52-4.99; P = 0.001).
PC < 70 × 109/L on 5POD is an independent predictor of death in the first year after LT. These results are in agreement with other studies that indicate that low PC after LT is associated with negative outcomes.
Core tip: Recent evidence shows that low platelet count (PC) can predict outcomes after liver transplantation (LT). We evaluated if a low PC in the immediate postoperative period of LT, defined as a PC < 70 × 109/L on the fifth postoperative day (5POD), is a predictor of death or retransplantation. We retrospectively assessed 480 consecutive LT patients. This study showed that a PC < 70 × 109/L on the 5POD was independently associated with shorter patient and graft survival within one year after LT. These results are in agreement with other studies indicating that thrombocytopenia in the immediate postoperative period of LT is associated with negative outcomes.