We congratulate Nixon et al.1 for the excellent survival rates in liver transplantation recipients. One explanation for the lack of the same dose-related increase in mortality in patients receiving platelet concentrates seen in our patients2 may lie in the type of platelets used. There are two basic methods for producing platelets for transfusion: the “buffy-coat” method using platelets derived from pooled random donors and the single donor pheresis-derived platelet-rich plasma method.3 As we discussed in our article, there is evidence that the latter is associated with a lower risk of immune-mediated and infectious complications than the former. In our program, it is common practice to use pooled random donor “buffy-coat” -derived platelets, and in a second analysis, we have recently demonstrated that the lower survival rates in patients who received platelets is explained by a significantly greater rate of early mortality because of acute lung injury (4.4% vs 0.4%; P = 0.004).4 From the comment by Nixon et al., it seems that the group in Auckland is using platelets collected by pheresis from single donors.
Altogether, the current results suggest that patients undergoing liver transplantation are at greater risk for early mortality because of acute lung injury after receiving platelets derived from pooled random donors, although this negative effect is not observed after transfusion of single donor pheresis-derived platelet concentrates. This is an important observation that deserves further investigation and confirmation.
Marieke T. de Boer, MD
Robert J. Porte MD, PhD
Department of Surgery
Section Hepatobiliary Surgery and Liver Transplantation
University Medical Center Groningen, University of Groningen
Groningen, The Netherlands
1. Nixon C, Gunn K, Main T, Young Y, McCall J. Platelets and Survival after Liver Transplantation. Anesth Analg 2009;108:1354–5
2. de Boer MT, Christensen MC, Asmussen M, van der Hilst CS, Hendriks HGD, Slooff MJH, Porte RJ. Impact of intraoperative transfusion of platelets and red blood cell on survival after liver transplantation. Anesth Analg 2008;106:32–44
3. Ness PM, Campbell-Lee SA. Single donor versus pooled random donor platelet concentrates. Curr Opin Hematol 2001;8: 392–6
4. Pereboom ITA, de Boer MT, Haagsma EB, Hendriks HGD, Lisman T, Porte RJ. Platelet transfusion during liver transplantation is associated with increased postoperative mortality due to acute lung injury. Anesth Analg. In press