Dualistic role of platelets in living donor liver transplantation: Are they harmful?
Dualistic role of platelets in living donor liver transplantation: Are they harmful?
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DOI：
10.3748/wjg.v28.i9.897
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发表时间：
2022-03-07
影响因子：
4.3
通讯作者：
Oda T
中科院分区：
文献类型：
--
作者：
Liang C;Takahashi K;Furuya K;Ohkohchi N;Oda T
血小板是一种主要参与止血和血栓形成的无核碎片，越来越多的证据表明，血小板在炎症、血管生成、再生和缺血/再灌注损伤（I/R损伤）中具有其他非止血潜能，参与了活体肝移植（LDLT）的生理病理过程。LDLT有时与再生受损和严重的I/R损伤相关，导致术后并发症和患者生存率降低。最近的研究表明，围手术期血小板减少与LDLT术后短期和长期移植物再生不良和术后发病率有关。虽然尚不完全清楚血小板减少症是原因还是结果，但在临床研究中经常建议增加血小板计数以改善移植后的预后。基于啮齿动物实验，先前的研究已经确定，血小板刺激肝部分切除术后的肝脏再生。然而，血小板在LDLT中的作用是有争议的，因为血小板被认为会加重肝脏的I/R损伤。最近，一个大鼠部分肝移植（LT）模型被用来证明手术前血小板生成素诱导的血小板增多加速了移植物再生，提高了移植后的存活率。研究表明，血小板来源的肝脏再生超过了部分肝移植后I/R损伤的相关风险。增加围手术期血小板计数的临床策略，如血小板生成素、血小板生成素受体激动剂和血小板输注，可能会改善LDLT后移植物再生和存活。
Platelets are anucleate fragments mainly involved in hemostasis and thrombosis, and there is emerging evidence that platelets have other nonhemostatic potentials in inflammation, angiogenesis, regeneration and ischemia/reperfusion injury (I/R injury), which are involved in the physiological and pathological processes during living donor liver transplantation (LDLT). LDLT is sometimes associated with impaired regeneration and severe I/R injury, leading to postoperative complications and decreased patient survival. Recent studies have suggested that perioperative thrombocytopenia is associated with poor graft regeneration and postoperative morbidity in the short and long term after LDLT. Although it is not fully understood whether thrombocytopenia is the cause or result, increasing platelet counts are frequently suggested to improve posttransplant outcomes in clinical studies. Based on rodent experiments, previous studies have identified that platelets stimulate liver regeneration after partial hepatectomy. However, the role of platelets in LDLT is controversial, as platelets are supposed to aggravate I/R injury in the liver. Recently, a rat model of partial liver transplantation (LT) was used to demonstrate that thrombopoietin-induced thrombocytosis prior to surgery accelerated graft regeneration and improved the survival rate after transplantation. It was clarified that platelet-derived liver regeneration outweighed the associated risk of I/R injury after partial LT. Clinical strategies to increase perioperative platelet counts, such as thrombopoietin, thrombopoietin receptor agonist and platelet transfusion, may improve graft regeneration and survival after LDLT.
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影响因子：
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