Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation

Iakovos Amygdalos; Zoltan Czigany; Jan Bednarsch; Joerg Boecker; Daniel Antonio Morales Santana; Franziska Alexandra Meister; Jelena von der Massen; Wen-Jia Liu; Pavel Strnad; Ulf Peter Neumann; Georg Lurje

doi:10.1007/s11605-019-04337-3

Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation

Iakovos Amygdalos, Zoltan Czigany, Jan Bednarsch, Joerg Boecker, Daniel Antonio Morales Santana, Franziska Alexandra Meister, Jelena von der Massen, Wen-Jia Liu, Pavel Strnad, Ulf Peter Neumann, Georg Lurje^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

7 Citations (Web of Science)

Abstract

BACKGROUND: Platelets (PLT) play an essential functional role in cellular injury and liver regeneration following partial hepatectomy and orthotopic liver transplantation (OLT). Here, we investigated the association of postoperative PLT counts with short- and long-term outcomes in adult OLT recipients.

METHODS: Three hundred consecutive patients from our prospective OLT database were analyzed retrospectively (May 2010-November 2017). Ninety-day post-OLT complications were graded using the Clavien-Dindo (CD) classification and quantified by the comprehensive complication index (CCI). To determine the prognostic accuracy of PLT counts, the area under the receiver operating characteristic curve (AUROC) was calculated for major complications (CD ≥ 3b). Parametric and non-parametric tests were applied for subgroup analyses. Uni- and multivariable logistic regression analyses were performed to identify risk factors for major complications. Graft and patient survival were analyzed using the Kaplan-Meier method as well as uni- and multivariable Cox regression analyses.

RESULTS: Postoperative day 6 PLT counts < 70 × 109/L (POD6-70) were identified as the best cutoff for predicting major complications (AUROC = 0.7; p < 0.001; Youden index 0.317). The stratification of patients into low- (n = 113) and high-PLT (n = 187) groups highlighted significant differences in major complications (CCI 68 ± 29 vs. 43 ± 28, p < 0.001); length of hospital and intensive care unit (ICU) stay (53 ± 43 vs. 31 ± 25, p < 0.001; 21 ± 29 vs. 7 ± 11, p < 0.001, respectively) and estimated procedural costs. POD6-70 was associated with inferior 5-year graft survival. Multivariable logistic regression analysis identified POD6-70 as an independent predictor of major complications (odds ratio 2.298, confidence intervals 1.179-4.478, p = 0.015).

CONCLUSION: In OLT patients, a PLT count on POD6 of less than 70 × 109/L bears a prognostic significance warranting further investigations.

Original language	English
Pages (from-to)	1996-2007
Number of pages	12
Journal	Journal of Gastrointestinal Surgery
Volume	24
Issue number	9
Early online date	6 Aug 2019
DOIs	https://doi.org/10.1007/s11605-019-04337-3
Publication status	Published - Sep 2020

Keywords

Orthotopic liver transplantation (OLT)
Thrombocytopenia
Morbidity
Mortality
Platelet counts
THROMBOCYTOPENIA
TRANSFUSION
IMPACT
INDEX
FAILURE

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10.1007/s11605-019-04337-3

Cite this

Amygdalos, I., Czigany, Z., Bednarsch, J., Boecker, J., Santana, D. A. M., Meister, F. A., von der Massen, J., Liu, W-J., Strnad, P., Neumann, U. P., & Lurje, G. (2020). Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation. Journal of Gastrointestinal Surgery, 24(9), 1996-2007. https://doi.org/10.1007/s11605-019-04337-3

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title = "Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation",

abstract = "BACKGROUND: Platelets (PLT) play an essential functional role in cellular injury and liver regeneration following partial hepatectomy and orthotopic liver transplantation (OLT). Here, we investigated the association of postoperative PLT counts with short- and long-term outcomes in adult OLT recipients.METHODS: Three hundred consecutive patients from our prospective OLT database were analyzed retrospectively (May 2010-November 2017). Ninety-day post-OLT complications were graded using the Clavien-Dindo (CD) classification and quantified by the comprehensive complication index (CCI). To determine the prognostic accuracy of PLT counts, the area under the receiver operating characteristic curve (AUROC) was calculated for major complications (CD ≥ 3b). Parametric and non-parametric tests were applied for subgroup analyses. Uni- and multivariable logistic regression analyses were performed to identify risk factors for major complications. Graft and patient survival were analyzed using the Kaplan-Meier method as well as uni- and multivariable Cox regression analyses.RESULTS: Postoperative day 6 PLT counts < 70 × 109/L (POD6-70) were identified as the best cutoff for predicting major complications (AUROC = 0.7; p < 0.001; Youden index 0.317). The stratification of patients into low- (n = 113) and high-PLT (n = 187) groups highlighted significant differences in major complications (CCI 68 ± 29 vs. 43 ± 28, p < 0.001); length of hospital and intensive care unit (ICU) stay (53 ± 43 vs. 31 ± 25, p < 0.001; 21 ± 29 vs. 7 ± 11, p < 0.001, respectively) and estimated procedural costs. POD6-70 was associated with inferior 5-year graft survival. Multivariable logistic regression analysis identified POD6-70 as an independent predictor of major complications (odds ratio 2.298, confidence intervals 1.179-4.478, p = 0.015).CONCLUSION: In OLT patients, a PLT count on POD6 of less than 70 × 109/L bears a prognostic significance warranting further investigations.",

keywords = "Orthotopic liver transplantation (OLT), Thrombocytopenia, Morbidity, Mortality, Platelet counts, THROMBOCYTOPENIA, TRANSFUSION, IMPACT, INDEX, FAILURE",

author = "Iakovos Amygdalos and Zoltan Czigany and Jan Bednarsch and Joerg Boecker and Santana, {Daniel Antonio Morales} and Meister, {Franziska Alexandra} and {von der Massen}, Jelena and Wen-Jia Liu and Pavel Strnad and Neumann, {Ulf Peter} and Georg Lurje",

year = "2020",

month = sep,

doi = "10.1007/s11605-019-04337-3",

language = "English",

volume = "24",

pages = "1996--2007",

journal = "Journal of Gastrointestinal Surgery",

issn = "1091-255X",

publisher = "Springer Verlag",

number = "9",

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Amygdalos, I, Czigany, Z, Bednarsch, J, Boecker, J, Santana, DAM, Meister, FA, von der Massen, J, Liu, W-J, Strnad, P, Neumann, UP & Lurje, G 2020, 'Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation', Journal of Gastrointestinal Surgery, vol. 24, no. 9, pp. 1996-2007. https://doi.org/10.1007/s11605-019-04337-3

Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation. / Amygdalos, Iakovos; Czigany, Zoltan; Bednarsch, Jan et al.

In: Journal of Gastrointestinal Surgery, Vol. 24, No. 9, 09.2020, p. 1996-2007.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation

AU - Amygdalos, Iakovos

AU - Czigany, Zoltan

AU - Bednarsch, Jan

AU - Boecker, Joerg

AU - Santana, Daniel Antonio Morales

AU - Meister, Franziska Alexandra

AU - von der Massen, Jelena

AU - Liu, Wen-Jia

AU - Strnad, Pavel

AU - Neumann, Ulf Peter

AU - Lurje, Georg

PY - 2020/9

Y1 - 2020/9

N2 - BACKGROUND: Platelets (PLT) play an essential functional role in cellular injury and liver regeneration following partial hepatectomy and orthotopic liver transplantation (OLT). Here, we investigated the association of postoperative PLT counts with short- and long-term outcomes in adult OLT recipients.METHODS: Three hundred consecutive patients from our prospective OLT database were analyzed retrospectively (May 2010-November 2017). Ninety-day post-OLT complications were graded using the Clavien-Dindo (CD) classification and quantified by the comprehensive complication index (CCI). To determine the prognostic accuracy of PLT counts, the area under the receiver operating characteristic curve (AUROC) was calculated for major complications (CD ≥ 3b). Parametric and non-parametric tests were applied for subgroup analyses. Uni- and multivariable logistic regression analyses were performed to identify risk factors for major complications. Graft and patient survival were analyzed using the Kaplan-Meier method as well as uni- and multivariable Cox regression analyses.RESULTS: Postoperative day 6 PLT counts < 70 × 109/L (POD6-70) were identified as the best cutoff for predicting major complications (AUROC = 0.7; p < 0.001; Youden index 0.317). The stratification of patients into low- (n = 113) and high-PLT (n = 187) groups highlighted significant differences in major complications (CCI 68 ± 29 vs. 43 ± 28, p < 0.001); length of hospital and intensive care unit (ICU) stay (53 ± 43 vs. 31 ± 25, p < 0.001; 21 ± 29 vs. 7 ± 11, p < 0.001, respectively) and estimated procedural costs. POD6-70 was associated with inferior 5-year graft survival. Multivariable logistic regression analysis identified POD6-70 as an independent predictor of major complications (odds ratio 2.298, confidence intervals 1.179-4.478, p = 0.015).CONCLUSION: In OLT patients, a PLT count on POD6 of less than 70 × 109/L bears a prognostic significance warranting further investigations.

AB - BACKGROUND: Platelets (PLT) play an essential functional role in cellular injury and liver regeneration following partial hepatectomy and orthotopic liver transplantation (OLT). Here, we investigated the association of postoperative PLT counts with short- and long-term outcomes in adult OLT recipients.METHODS: Three hundred consecutive patients from our prospective OLT database were analyzed retrospectively (May 2010-November 2017). Ninety-day post-OLT complications were graded using the Clavien-Dindo (CD) classification and quantified by the comprehensive complication index (CCI). To determine the prognostic accuracy of PLT counts, the area under the receiver operating characteristic curve (AUROC) was calculated for major complications (CD ≥ 3b). Parametric and non-parametric tests were applied for subgroup analyses. Uni- and multivariable logistic regression analyses were performed to identify risk factors for major complications. Graft and patient survival were analyzed using the Kaplan-Meier method as well as uni- and multivariable Cox regression analyses.RESULTS: Postoperative day 6 PLT counts < 70 × 109/L (POD6-70) were identified as the best cutoff for predicting major complications (AUROC = 0.7; p < 0.001; Youden index 0.317). The stratification of patients into low- (n = 113) and high-PLT (n = 187) groups highlighted significant differences in major complications (CCI 68 ± 29 vs. 43 ± 28, p < 0.001); length of hospital and intensive care unit (ICU) stay (53 ± 43 vs. 31 ± 25, p < 0.001; 21 ± 29 vs. 7 ± 11, p < 0.001, respectively) and estimated procedural costs. POD6-70 was associated with inferior 5-year graft survival. Multivariable logistic regression analysis identified POD6-70 as an independent predictor of major complications (odds ratio 2.298, confidence intervals 1.179-4.478, p = 0.015).CONCLUSION: In OLT patients, a PLT count on POD6 of less than 70 × 109/L bears a prognostic significance warranting further investigations.

KW - Orthotopic liver transplantation (OLT)

KW - Thrombocytopenia

KW - Morbidity

KW - Mortality

KW - Platelet counts

KW - THROMBOCYTOPENIA

KW - TRANSFUSION

KW - IMPACT

KW - INDEX

KW - FAILURE

U2 - 10.1007/s11605-019-04337-3

DO - 10.1007/s11605-019-04337-3

M3 - Article

C2 - 31388889

VL - 24

SP - 1996

EP - 2007

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 9

ER -