Observational Study
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World J Gastroenterol. Sep 7, 2014; 20(33): 11871-11877
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11871
Low immediate postoperative platelet count is associated with hepatic insufficiency after hepatectomy
Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Wen-Tao Wang, Lu-Nan Yan
Hai-Qing Wang, Jian Yang, Jia-Yin Yang, Wen-Tao Wang, Lu-Nan Yan, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: All authors contributed equally to this work and designed the research; Yang J, Yang JY and Wang WT analyzed and interpreted the data; Wang HQ and Yan LN drafted the manuscript; all authors have read and approved the final manuscript.
Supported by Grants from the National Science and Technology Major Project of China, No.2012ZX10002-016 and No.2012ZX10002-017
Correspondence to: Lu-Nan Yan, MD, PhD, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. yanlunan_688@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: January 26, 2014
Revised: March 27, 2014
Accepted: April 30, 2014
Published online: September 7, 2014
Abstract

AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma (HCC).

METHODS: In a cohort of 565 consecutive hepatitis B-related HCC patients who underwent major liver resection, the characteristics and clinical outcomes after liver resection were compared between patients with immediate postoperative platelet count < 100 × 109/L and patients with platelet count ≥ 100 × 109/L. Risk factors for postoperative hepatic insufficiency were evaluated by multivariate analysis.

RESULTS: Patients with a low immediate postoperative platelet count (< 100 × 109/L) had more grade III-V complications (20.5% vs 12.4%, P = 0.016), and higher rates of postoperative liver failure (6.8% vs 2.6%, P = 0.02), hepatic insufficiency (31.5% vs 21.2%, P < 0.001) and mortality (6.8% vs 0.5%, P < 0.001), compared to patients with a platelet count ≥ 100 × 109/L. The alanine aminotransferase levels on postoperative days 3 and 5, and bilirubin on postoperative days 1, 3 and 5 were higher in patients with immediate postoperative low platelet count. Multivariate analysis revealed that immediate postoperative low platelet count, rather than preoperative low platelet count, was a significant independent risk factor for hepatic insufficiency.

CONCLUSION: A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver.

Keywords: Thrombocytopenia, Hepatic insufficiency, Hepatocellular carcinoma, Hepatectomy, Hepatitis B

Core tip: Recent animal experiments suggested that platelets not only have a role in hemostasis and thrombogenesis, but can also improve liver function by mediating liver regeneration. Our study found that patients with a low immediate postoperative platelet count < 100 × 109/L had more grade III-V complications, and higher rates of postoperative liver failure, hepatic insufficiency and mortality. In addition, these patients had worse liver function after liver resection, with higher alanine aminotransferase and bilirubin and lower albumin levels. This indicated that platelets could mediate liver regeneration in cirrhotic liver.