Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2019; 11(1): 99-108
Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.99
Low platelet count: Predictor of death and graft loss after liver transplantation
Pedro Beltrame, Santiago Rodriguez, Ajacio Bandeira de Mello Brandão
Pedro Beltrame, Santiago Rodriguez, Ajacio Bandeira de Mello Brandão, Graduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
Pedro Beltrame, Ajacio Bandeira de Mello Brandão, Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, Brazil
Author contributions: Beltrame P conceptualized and designed the data, collected the data, analyzed and interpreted the data, drafted the article, and critically revised the article; Rodriguez S collected the data, and critically revised the article; Brandão ABM conceptualized and designed the data, analyzed and interpreted the data, drafted the article, and critically revised the article; all authors have read and approved of the final version of the article.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Santa Casa de Misericórdia de Porto Alegre (No. 1.183.375).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no financial relationships relevant to this article to disclose. Santiago Rodriguez is a CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) scholarship recipient.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ajacio Bandeira de Mello Brandão, MD, Associate Professor, Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Eng. Álvaro Nunes Pereira, 400/402, Porto Alegre 90570-110, RS, Brazil. ajaciob@gmail.com
Telephone: +55-51-32253682 Fax: +55-51-32253682
Received: October 7, 2018
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

To confirm the hypothesis that a low PC after LT is a predictor of death or graft loss.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.