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
Platelets have several functions and exert dichotomous effects on the graft and on the patient in the context of liver transplantation (LT). Low platelet count (PC) after LT is associated with higher rates of complications. However, it is not clear whether low PC in the postoperative period is the cause or a surrogate marker of negative outcomes.
The accurate prediction of which LT recipients will do well and which ones will have serious complications remains somewhat elusive. Some authors suggest that low PC after LT can predict early posttransplant survival or graft loss. Confirmation of these findings can provide the clinician with the opportunity to intervene early and theoretically change the postoperative course of the patient.
To confirm the hypothesis that a low PC after LT is a predictor of death or graft loss.
We performed a retrospective database analysis. PC from the preoperative to the seventh postoperative day (POD) were considered. C-statistic analysis was adopted to establish the day on which the PC showed the best performance. Recursive analyses of receiver operating characteristics curves allowed us to identify the cutoff point. 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.
PC < 70 × 109/L on 5POD was defined as the ideal cutoff point for predicting death and retransplantation. PC < 70 × 109/L on 5POD was an independent risk factor for death at 12 mo after LT. In the Cox regression, patients with PC < 70 × 109/L on 5POD had worse graft survival rates up to one year after LT.
A low PC on 5POD was associated with graft loss and mortality one year after LT. This result is in agreement with previous studies indicating that low PC in the immediate postoperative period of after LT is associated with negative outcomes.
Our results reinforce the need to evaluate the role of interventions to maintain a minimum PC after LT. Preventive measures, such as platelet transfusion, suspension of potentially myelosuppressive drugs, and administration of serotonin or thrombopoietin, could be used in the future in the LT setting. However, further studies are still required before these interventions can be considered in clinical practice.