Low Platelet Counts After Liver Transplantation Predict Early Posttransplant Survival: The 60-5 Criterion
Low Platelet Counts After Liver Transplantation Predict Early Posttransplant Survival: The 60-5 Criterion
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DOI：
10.1002/lt.23759
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发表时间：
2014-02-01
影响因子：
4.6
通讯作者：
Clavien, Pierre-Alain
中科院分区：
文献类型：
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作者：
Lesurtel, Mickael;Raptis, Dimitri A.;Clavien, Pierre-Alain
血小板在肝损伤和再生中起着关键作用。血小板减少症与部分肝切除术后并发症的增加有关，但目前尚不清楚血小板计数是否也可以预测移植后的结果，这是一种经常在血小板减少症患者中进行的手术。因此，本研究的目的是评估血小板计数是否可以作为肝移植（LT）后短期和长期结局的指标。从我们的前瞻性数据库中分析了257例连续LT接受者（2003年1月至2011年12月）。记录术前和术后每日血小板计数，直至术后第7天（POD 7）。进行单变量和多变量分析，以评估围手术期血小板计数低是否是术后并发症和移植物和患者生存的危险因素。移植前血小板计数中位数为88 × 10（9）/L [四分位数间距（IQR）=58-127 × 10（9）/L]。最低血小板计数发生在POD 3：中位数为56 x 10（9）/L（IQR=41-86 x 10（9）/L）。POD 5时血小板计数低的患者严重（IIIb/IV级）并发症的发生率较高[39% vs 29%，比值比（OR）=1.09（95% CI=1.1-3.3），P=0.02]，90天死亡率较高[16% vs 8%，OR=2.25（95% CI=1.0-5.0），P=0.05]。在多变量分析中，POD 5血小板计数
Platelets play a critical role in liver injury and regeneration. Thrombocytopenia is associated with increases in postoperative complications after partial hepatectomy, but it is unknown whether platelet counts could also predict outcomes after transplantation, a procedure that is often performed in thrombocytopenic patients. Therefore, the aim of this study was to evaluate whether platelet counts could be indicators of short- and long-term outcomes after liver transplantation (LT). Two hundred fifty-seven consecutive LT recipients (January 2003-December 2011) from our prospective database were analyzed. Preoperative and daily postoperative platelet counts were recorded until postoperative day 7 (POD7). Univariate and multivariate analyses were performed to assess whether low perioperative platelet counts were a risk factor for postoperative complications and graft and patient survival. The median pretransplant platelet count was 88 x 10(9)/L [interquartile range (IQR)=58-127 x 10(9)/L]. The lowest platelet counts occurred on POD3: the median was 56 x 10(9)/L (IQR=41-86 x 10(9)/L). Patients with low platelet counts on POD5 had higher rates of severe (grade IIIb/IV) complications [39% versus 29%, odds ratio (OR)=1.09 (95% CI=1.1-3.3), P=0.02] and 90-day mortality [16% versus 8%, OR=2.25 (95% CI=1.0-5.0), P=0.05]. In the multivariate analysis, POD5 platelet counts