Prolonged thrombocytopenia after living donor liver transplantation is a strong prognostic predictor irrespective of history of splenectomy: the significance of ADAMTS13 and graft function.
Prolonged thrombocytopenia after living donor liver transplantation is a strong prognostic predictor irrespective of history of splenectomy: the significance of ADAMTS13 and graft function.
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无论脾切除史如何，活体肝移植后长期血小板减少症是一个强有力的预后预测因素：ADAMTS13 和移植物功能的意义。
DOI：
10.1007/s12185-014-1543-9
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Isaji S.
中科院分区：
文献类型：
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作者：
Nobuoka Y1;Wada H;Mizuno S;Kishiwada M;Usui M;Sakurai H;Tabata M;Kobayashi T;Nobori T;Uemoto S;Isaji S.
活体肝移植（LDLT）后延长血小板减少的确切机制尚不清楚。确定LDLT后延长血小板减少的相关危险因素，重点关注ADAMTS13（一种具有血小板反应蛋白1型基序成员13的崩解素样和金属蛋白酶）的活性和脾切除术的影响。根据血小板计数（100 × 103/μL），将成人LDLT患者分为两组：高血小板组和低血小板组（HP和LP）。对100例患者进行生存分析，并测量65例成人受体血浆中ADAMTS13活性和血管性血友病因子（VWF）水平。LP组（n= 36）的6个月生存率显著低于HP组（n= 62）（61.1%比93.5%）。LP组（n= 23） ADAMTS13活性明显低于HP组（n= 42）。LP组VWF/ADAMTS13比值显著高于HP组。POD14血小板减少的独立危险因素是术前AT水平和ADAMTS13在POD14的活性。尽管血小板水平较低，但LP组POD14上的TPO水平明显高于HP组，而LP组POD28上的TPO水平明显降低。无论脾切除术史如何，LP组的血小板计数和ADAMTS13活性在POD28之前都保持较低水平，而VWF/ADAMTS13比值在POD28之前显著升高。这些结果表明，LDLT后延长的血小板减少不仅与窦内皮细胞损伤引起的ADAMTS13降低有关，而且与肝细胞功能障碍引起的TPO产生低有关，与脾切除术史无关。
The precise mechanism of prolonged thrombocytopenia following living donor liver transplantation (LDLT) remains unclear. To determine risk factors associated with prolonged thrombocytopenia following LDLT, with a focus on the activity of ADAMTS13 (a disintegrin-like and metalloproteinase with thrombospondin type-1 motifs member 13) and the influence of splenectomy. Adult LDLT patients were divided into two groups on the basis of platelet counts (100 × 103/μL) on POD 14: high and low platelet (HP and LP) groups. Survival analysis was performed in the 100 patients, and ADAMTS13 activity and von Willebrand factor (VWF) levels in the plasma were measured in 65 adult recipients. The 6-month survival rate was significantly lower in the LP group (n= 36) than in the HP group (n= 62) (61.1 vs. 93.5 %). ADAMTS13 activity had been significantly lower in the LP group (n= 23) than in the HP group (n= 42). The VWF/ADAMTS13 ratio was significantly higher in the LP group than in the HP group. The independent risk factors for thrombocytopenia on POD14 were preoperative AT levels and ADAMTS13 activity on POD14. TPO levels on POD14 were significantly higher in the LP group than in the HP group, while those on POD28 in the LP group were significantly decreased, despite the low platelet levels. Irrespective of splenectomy history, platelet counts and ADAMTS13 activity in the LP group remained low until POD28, while VWF/ADAMTS13 ratio significantly increased until POD28. These results suggest that prolonged thrombocytopenia after LDLT was associated with not only a decrease in ADAMTS13 due to sinusoidal endothelial cell injury, but also low TPO production due to hepatocyte dysfunction, irrespective of history of splenectomy.