Chang Jae-Hyuck, Choi Jong-Young, Woo Hyun-Young, Kwon Jung-Hyun, You Chan-Ran, Bae Si-Hyun, Yoon Seung-Kew, Choi Myung-Gyu, Chung In-Sik, Kim Dong-Goo
Department of internal medicine, college of medicine, The Catholic University of Korea, Seoul 137-040, Korea.
World J Gastroenterol. 2008 Oct 7;14(37):5723-9. doi: 10.3748/wjg.14.5723.
To compare the recovery of thrombocytopenia and splenomegaly during long-term follow-up after liver transplantation in patients receiving a living donor transplant or a cadaveric donor transplant.
This was a retrospective cohort study of 216 consecutive liver transplant patients who survived for > 6 mo after transplantation; 169 received a liver transplant from a living donor and 47 from a cadaveric donor. The platelet counts or spleen volumes were examined before transplant, 1, 6, and 12 mo after transplant, and then annually until 5 years after transplant.
The mean follow-up period was 49 mo (range, 21-66). Platelet counts increased continuously for 5 years after orthotopic liver transplant. The restoration of platelet counts after transplant was significantly slower in patients with severe pretransplant thrombocytopenia (< 50,000/microL) until 4 years after transplant (P = 0.005). Donor type did not significantly affect the recovery of platelet count and spleen volume in either patient group. In multivariate analysis, pretransplant severe thrombocytopenia (< 50,000/microL) was an independent factor associated with sustained thrombocytopenia (P < 0.001, odds ratio 6.314; confidence interval, 2.828-14.095). Thrombocytopenia reappeared after transplant in seven patients with portal flow disturbance near the anastomosis site.
Our study suggests that severe thrombocytopenia before transplant is closely associated with delayed recovery of platelet count after transplant and donor type did not affect the recovery of thrombocytopenia. The reappearance of thrombocytopenia after transplant should be considered a possible indicator of flow disturbance in the portal vein.
比较活体供肝移植和尸体供肝移植患者肝移植术后长期随访期间血小板减少症和脾肿大的恢复情况。
这是一项对216例移植后存活超过6个月的连续肝移植患者进行的回顾性队列研究；169例接受活体供肝移植，47例接受尸体供肝移植。在移植前、移植后1、6和12个月检查血小板计数或脾脏体积，然后每年检查一次，直至移植后5年。
平均随访期为49个月（范围21 - 66个月）。原位肝移植后血小板计数持续增加5年。移植前严重血小板减少（<50,000/微升）的患者，直到移植后4年，移植后血小板计数的恢复明显较慢（P = 0.005）。供体类型对两组患者的血小板计数和脾脏体积恢复均无显著影响。多因素分析显示，移植前严重血小板减少（<50,000/微升）是与持续性血小板减少相关的独立因素（P < 0.001，比值比6.314；可信区间2.828 - 14.095）。7例吻合口附近门静脉血流紊乱的患者移植后血小板减少症复发。
我们的研究表明，移植前严重血小板减少与移植后血小板计数恢复延迟密切相关，供体类型不影响血小板减少症的恢复。移植后血小板减少症的复发应被视为门静脉血流紊乱的可能指标。
