Thrombocytopenia in liver transplant recipients - Predictors, impact on fungal infections, and role of endogenous thrombopoietin
Thrombocytopenia in liver transplant recipients - Predictors, impact on fungal infections, and role of endogenous thrombopoietin
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DOI：
10.1097/00007890-200001150-00014
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发表时间：
2000-01-15
期刊：
影响因子：
6.2
通讯作者：
Marino, IR
中科院分区：
文献类型：
--
作者：
Chang, FY;Singh, N;Marino, IR
背景血小板减少症是肝移植受者常见的潜在严重并发症。肝移植受者内源性血小板生成素水平在移植后血小板减少症中的作用尚未完全明确。此外，有越来越多的证据表明，血小板在抗微生物宿主防御中起着重要作用。血小板减少症的预测变量及其对感染发病率和预后的影响，以及血小板生成素（TPO）血清浓度;结果：移植前血小板计数中位数为67 × 10（3）/cmm，肝移植后血小板计数中位数最低值为33 × 10（3）/cmm，平均在移植后6天达到，移植前血小板计数较低（r = +.068，P = .0001），移植前血清白蛋白较低（r =+0.39，P = .014），手术时间较长（r = 0.27，P = 0.05），术中红细胞压积较高（r = 0.28，P = .049）和新鲜冷冻血浆输注（r = 0.42，P = .004），第7天胆红素升高（r =-0.386，P = 0.005），以及移植后第7天较高的血清肌酐（r =-0.031，P = 0.025）与移植后较低的血小板最低值显著相关。死亡者血小板计数的最低值显著低于存活者（16 vs. 366 × 10（3）/cmm，P = .0001）。血小板计数最低值小于或等于30 x10（3）/cmm的患者中有43%（9/21）在移植后30天内发生严重感染，而血小板计数最低值> 30 x10（3）/cmm的患者中有17%（5/29）在移植后30天内发生严重感染（P = 0.04）。在血小板计数最低值小于或等于30 × 103/cmm的患者中，14%的患者发生真菌感染，而在血小板计数最低值> 30 × 103/cmm的患者中，0%的患者发生真菌感染（P = .06）;所有真菌感染患者在真菌感染前血小板计数最低值小于或等于30 × 10（3）/cm，血小板计数的最低值比首次严重感染早7天。移植前TPO水平在存活组（平均103 pg/ml）和死亡组（平均144 pg/ml）之间无差异。移植后两组TPO水平均升高。TPO水平在第7天达到峰值，随后在存活者中下降。尽管TPO水平逐渐升高，但未存活者仍有持续性血小板减少;与存活者相比，未存活者在第7天（P = .02）、第9天（P = .0019）和第14天（P = .04）的TPO水平显著升高。持续性血小板减少症预示着肝移植受者的不良结局，与低TPO水平无关。血小板减少症先于感染，并确定了一个易患早期重大感染的肝移植患者亚组;其在真菌感染中的确切作用需要在更大规模的研究中进行验证。
Background. Thrombocytopenia is a frequent and potentially serious complication in liver transplant recipients. The role of endogenous thrombopoietin level in posttransplant thrombocytopenia, has not been fully defined in liver transplant recipients. Additionally, there is accumulating evidence to suggest that platelets play a important role in antimicrobial host defense.Methods, There were 50 consecutive Liver transplant recipients studied. Variables predictive of thromobocytopenia, its impact on infections morbidity and outcome, and serial thrombopoietin (TPO) serum concen-; tration were assessed.Results, The median pretransplant platelet count was 67x10(3)/cmm, After the liver transplantation, the median nadir platelet count was 33x10(3)/cmm and was reached a mean of 6 days after the transplant, A lower pretransplant platelet count (r = +.068, P = .0001), lower serum albumin before the transplants (r = +0.39, P = .014), longer operation time (r = 0.27, P = .05), higher intraoperative packed red cells (r = 0.28, P = .049) and fresh frozen plasma transfusions (r = 0.42, P = .004), higher bilirubin at Day 7 (r = -.386, P = .005), and higher serum creatinine at Day 7 after the transplants (r = -.031, P = .025) correlated significantly with a lower nadir in platelets after the transplant. Nadir in platelet count was significantly lower in nonsurvivors compared with survivors (16 vs, 366x10(3)/cmm, P = .0001). Forty-three percent (9 of 21) of the patients with nadir platelet counts of less than or equal to 30x10(3)/cmm had a major infection within 30 days of the transplant compared with 17% (5 of 29) with nadir platelet counts > 30x10(3)/cmm (P = .04). Fungal infections occurred in 14% of the patients with nadir platelet counts of less than or equal to 30x10(3)/cmm versus 0% in those with nadir platelet counts of > 30x103/cmm (P = .06); all patients with fungal infections had nadir platelet counts of less than or equal to 30x10(3)/ cmm before fungal infection, Nadir in platelet count preceded the first major infection by a median of 7 days. Pretransplant TPO level did not differ between survivors (mean 103 pg/ml) or nonsurvivors (mean 144 pg/ml), After the transplantation, TPO levels increases in both groups. TPO level peaked at Day 7 and subsequently declined in survivors. Nonsurvivors had persistent thrombocytopenia despite a progressive rise in TPO level; TPO level was significantly higher at Day 7 (P = .02), Day 9 (P = .0019), and Day 14 (P = .04) in nonsurvivors compared with survivors.Conclusion. Persistent thrombocytopenia portended a poor outcome in liver transplant recipients and was not related to low TPO levels, Thrombocytopenia preceded infections and identified a subgroup of liver transplant patients susceptible to early major infections; its precise role in fungal infections warrants validation in larger studies.