THROMBOCYTOPENIA POST LIVER-TRANSPLANTATION - CORRELATIONS WITH PREOPERATIVE PLATELET COUNT, BLOOD-TRANSFUSION REQUIREMENTS, ALLOGRAFT FUNCTION AND OUTCOME
THROMBOCYTOPENIA POST LIVER-TRANSPLANTATION - CORRELATIONS WITH PREOPERATIVE PLATELET COUNT, BLOOD-TRANSFUSION REQUIREMENTS, ALLOGRAFT FUNCTION AND OUTCOME
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DOI：
10.1016/s0168-8278(05)80089-3
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发表时间：
1992-09-01
影响因子：
25.7
通讯作者：
SHEIL, AGR
中科院分区：
文献类型：
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作者：
MCCAUGHAN, GW;HERKES, R;SHEIL, AGR
本研究报道，血小板减少是肝移植后的普遍现象。在53例连续接受肝移植的成人患者中，血小板计数平均下降63% (157 × 10（9)/l至50 × 10(9)/l）。血小板计数在移植后第5天达到最低点，但在第14天恢复到术前水平。非参数回归分析发现，术前血小板计数、输血需水量和术后最大ALT值是血小板计数下降百分比的独立预测因子。与接枝冷缺血时间的长短或威斯康星大学溶液的使用没有相关性。最低点与术后胆红素和ALT最大值、移植物缺血时间和UW溶液的使用有关。最大术后ALT也是血小板计数最低点的独立预测因子。据观察，住院后未存活的患者术后血小板计数较低，且在第14天未恢复到术前水平。血小板计数下降百分比是生存率的独立预测因子。重度血小板减少伴脑出血3例。该报告提供的证据表明，同种异体移植物功能障碍（术后最大胆红素和/或AST/ALT）是肝移植后血小板计数最低点、最低点日和血小板计数百分比下降的最一致的独立预测因子，尽管血小板变化的确切机制仍不确定。
This study reports that thrombocytopenia is a universal phenomenon post hepatic transplantation. In 53 consecutive adult patients undergoing liver transplantation the platelet count fell by a mean of 63% (157 x 10(9)/l to 50 x 10(9)/l). The platelet count reached a nadir at Day 5 post-transplant but returned to pre-operative levels by Day 14. Non-parametric regression analysis found that pre-operative platelet count, blood transfusion requirements and maximum post-operative ALT values were independent predictors of the percentage fall in platelet count. No correlation was seen with length of graft cold ischaemic time or the use of University of Wisconsin (UW) solution. The nadir day correlated with maximum post-operative bilirubin and ALT, graft ischaemic time and use of UW solution. Maximum post-operative ALT was also an independent predictor of nadir platelet count. It was observed that patients who did not survive the hospital admission had lower post-operative platelet counts and these did not return to pre-operative levels by Day 14. The percentage fall in platelet count was an independent predictor of survival. Severe thrombocytopenia was associated with cerebral haemorrhage in 3 patients. This report provides evidence that allograft dysfunction (maximum post-operative bilirubin and/or AST/ALT) was the most consistent independent predictor of the nadir platelet count, nadir day and percentage fall in platelet count post liver transplantation although the exact mechanism(s) of the platelet changes remain uncertain.