Association Between Intraoperative Platelet Transfusion and Early Graft Regeneration in Living Donor Liver Transplantation

Han, Seok Joo; Park, Hyo-Won; Song, Ji Hyeon; Gwak, Mi Sook; Lee, Won Jae; Kim, Gaab Soo; Lee, Suk-Koo; Ko, Justin Sangwook

doi:10.1097/sla.0000000000001526

Cited by 62 publications

(73 citation statements)

References 26 publications

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“…Further, low platelet counts at the onset of liver regeneration are independently associated with delayed liver function recovery after liver resection as well as transplantation [12,13]. Furthermore, we were recently able to provide clinical evidence that perioperative thrombopoietin (TPO) dynamics, the prime regulator platelet production, was associated with a significantly increased risk of postoperative liver dysfunction [14], thereby further strengthening the central role of platelets in liver regeneration.…”

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confidence: 79%

“…Therefore, TPO might represent a potential therapeutic target as TPO mimetics are approved and in clinical use. Moreover, platelet transfusion has been suggested to be beneficial for early graft regeneration after living donor liver transplantation [13]. Besides, the modulation of platelet counts, pharmacological modulation of perioperative hepatic hemodynamics might represent a tool to modulate platelet activation.…”

Section: Platelets As Therapeutic Target?mentioning

confidence: 99%

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Importance of platelet-derived growth factors in liver regeneration

Starlinger

Assinger

2016

Expert Review of Gastroenterology & Hepatology

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confidence: 79%

Section: Platelets As Therapeutic Target?mentioning

confidence: 99%

Importance of platelet-derived growth factors in liver regeneration

Starlinger

Assinger

2016

Expert Review of Gastroenterology & Hepatology

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“…In addition, the stable late posttransplant phase might provide another time window for targeting the latent metastasis with less concern about bleeding complications or graft regeneration. (22,37) Therapies that can differentiate the platelet-cancer loop from coagulation or tissue regeneration pathways represent opportunities to prevent metastasis with minimum related complications. Third, our findings suggest that restrictive perioperative platelet transfusion policies might have another advantage from the viewpoint of metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative PLT was negatively associated with the amount of transfused platelets during surgery (coefficient -0.49; P < 0.001), during the first week after surgery (coefficient -0.55; P < 0.001), and between 1 and 2 weeks after surgery (coefficient -0.21; P < 0.001). Accordingly, the amount of transfused platelets during surgery, during the first week after surgery, and between 1 and 2 weeks after surgery was 0 (0-6), 9 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and 0 (0-0) units in the low platelet group and 0 (0-0), 0 (0-4), and 0 (0-0) units in the high platelet group, respectively, where 1 unit of apheresis platelets was considered to be equivalent to 6 units of platelets, as described previously. (22) Minimum PLT measured at each postoperative day during the first 2 weeks after transplantation was consistently <30 3 10 9 /L in median within the subgroup of recipients who underwent platelet transfusion on each corresponding day, indicating that platelet transfusion was performed according to our standardized protocol targeting PLT >30 3 10 9 /L (Supporting Fig.…”

Section: Association Between Perioperative Plt and Platelet Transfusionmentioning

confidence: 99%

Risk of posttransplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation

Han¹,

Lee

Yang

et al. 2017

Liver Transpl

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Platelets interact with tumor cells and promote metastasis. The importance of platelets in posttransplant hepatocellular carcinoma (HCC) recurrence is unclear. Thus, we aimed to evaluate the association between preoperative platelet count (PLT) and HCC recurrence after living donor liver transplantation. Of 359 recipients of livers from living donors for HCC, 209 of 240 patients who had preoperative PLT £ 75 3 10 9 /L were matched with 97 of 119 patients who had preoperative PLT >75 3 10 9 /L using propensity score matching, with an unfixed matching ratio based on factors such as tumor biology. The cutoff value of 75 3 10 9 /L was set based on optimum stratification analysis. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence. The median follow-up time was 59 months. Before matching, recurrence probability at 1, 2, and 5 years after transplantation was 4.7%, 9.2%, and 11.3% for the low platelet group and 14.5%, 23.0%, and 30.5% for the high platelet group. Recurrence risk was significantly greater in the high platelet group in both univariate (hazard ratio [HR] 5 3.09; 95% confidence interval [CI], 1.86-5.14; P < 0.001) and multivariate analyses (HR 5 2.10; 95% CI, 1.23-3.60; P 5 0.007). In the matched analysis, recurrence risk was also greater in the high platelet group in both univariate (HR 5 2.33; 95% CI, 1.36-4.01; P 5 0.002) and multivariate analyses (HR 5 1.90; 95% CI, 1.02-3.54; P 5 0.04). Preoperative PLT had no interaction with the Milan criteria, alpha-fetoprotein level, Edmonson grade, microvascular invasion, or intrahepatic metastasis. Incorporation of preoperative PLT into the Milan criteria significantly improved predictive power. Inflammation-based scores including neutrophil-tolymphocyte ratio, platelet-to-lymphocyte ratio, and the inflammation-based index did not show superiority to preoperative PLT in predicting HCC recurrence. In conclusion, preoperative PLT appears to be an important host factor affecting HCC recurrence after living donor liver transplantation.Liver Transplantation 24 44-55 2018 AASLD. Liver transplantation is a well-established therapeutic option for treatment of hepatocellular carcinoma (HCC), addressing both underlying liver disease, which is considered a premalignant lesion, and tumor burden. However, many recipients experience tumor recurrence and recurrent HCC is a major cause of death. Thus, better understanding of the contributing factors for HCC metastasis will help improve liver transplant outcome. (1,2) The platelet is the primary cell for hemostasis and tissue repair, (3) but extensive experimental evidence has also illuminated the involvement of platelets in tumor growth and metastasis. (4)(5)(6) Clinical evidence has demonstrated an association between higher platelet counts (PLTs) and shorter survival time and increased recurrence after treatment in various solid tumors. (7) In terms of HCC, a retrospective analysis using a large database of biopsy-proven HCC patients reported a positive Abbrevi...

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“…Liver regeneration starts with a well‐organized and complex series of signals which is generated by cytokines and growth factors . Accumulating evidence from in vitro and in vivo studies suggests that platelets have a pivotal role in liver regeneration . In animal models in which platelets were depleted or functionally impaired, liver regeneration was substantially delayed after a partial liver resection .…”

Section: Introductionmentioning

confidence: 99%