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Low Platelet Counts and Prolonged Prothrombin Time Early After Operation Predict the 90 Days Morbidity and Mortality in Living-donor Liver Transplantation

Akamatsu, Nobuhisa MD; Sugawara, Yasuhiko MD; Kanako, Junichi MD; Arita, Junichi MD; Sakamoto, Yoshihiro MD; Hasegawa, Kiyoshi MD; Kokudo, Norihiro MD

doi: 10.1097/SLA.0000000000001634
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Objective: The aim of the study was to investigate the association between platelet count/prothrombin time early after transplant and short-term outcomes among living-donor liver transplant (LDLT) recipients.

Background: Postoperative platelet count and prothrombin time-international normalized ratio (PT-INR) were critical biomarkers in LDLT.

Methods: The study participants consisted of 445 initial LDLT recipients, and perioperative variables, including platelet count and PT-INR, were assessed for their association with severe complications (Clavien-Dindo classification grade IIIb/IV) and mortality within 90 days after operation.

Results: Severe complications and operative mortality occurred in 161 (36%) and 23 patients (5%), respectively. Cox regression analysis revealed that a high body mass index [hazard ratio (HR) 1.2; 95% confidence interval (CI), 1.1–1.4; P = 0.004] and low platelet count on postoperative day (POD)3 (HR 0.88; 95% CI, 0.57–0.97; P < 0.001) were independent predictors for grade IIIb/IV complications after LDLT, whereas high PT-INR on POD5 (HR 1.1; 95% CI, 1.1–1.3; P = 0.021) was the only independent factor for operative mortality. In addtion, the progonostic scoring with low platelet count (<50 × 109/L) and prolonged prothrombin time (PT-INR >1.6) within POD5, 1 point for each, was demonstrated to be useful in predicting the development of Clavien-Dindo grade IIIb/IV/V complications after LDLT (30% for score 0, 46% for score 1, and 72% for score 2: 0 vs 1, P = 0.004; 0 vs 2, P < 0.001; 1 vs 2, P = 0.002).

Conclusions: PT-INR above 1.6 and platelet count below 50 × 109/L within POD5 were useful predictors of mortality and severe complications after LDLT.

Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Reprints: Norihiro Kokudo, MD, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: KOKUDO-2SU@h.u-tokyo.ac.jp.

Co-correspondence: Nobuhisa Akamatsu, MD, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: nakamats-tky@umin.ac.jp.

Disclosures: The authors of this manuscript have no conflicts of interest and no funding to disclose as described by the Annals of Surgery.

Authorship: N.A. conducted the study, collected the data, processed the data, wrote the manuscript, and was responsible for proofreading the manuscript. Y.S., J.K., J.A., Y.S., and K.H. proofread and approved the manuscript. N.K. performed critical review and proofread the manuscript.

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