Department of Critical Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).
Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).
Ann Transplant. 2023 Dec 29;28:e941583. doi: 10.12659/AOT.941583.
BACKGROUND Studies have shown that increased platelet aggregation in patients with decompensated cirrhosis indicates higher risk of further decompensation and death, but studies on the association between platelet aggregation function and early postoperative survival in orthotopic liver transplantation (OLT) patients are rare. We conducted a retrospective study to investigate whole-blood platelet aggregation during the perioperative period of OLT patients and its association with clinical outcomes. MATERIAL AND METHODS Adult patients who underwent OLT between January 1 and April 30, 2021 were retrospectively reviewed. Laboratory test results indicating primary hemostasis were analyzed. The generalized linear model was used to investigate the association between primary hemostasis parameters and survival. RESULTS A total of 256 patients were enrolled. The median platelet count (PLT) was 61.5 (39.5-106.3)×109/L before transplantation. The median MA value was 43.1 (34.5-56.2) mm. From the 1st to the 3rd day after transplantation, PLT and MA both indicated a significant decrease. Two weeks after transplantation, PLT rose to 143.0 (85.0-209.0)×10⁹/L, and the MA value rose to 56.7 (52.2-62.7) mm. On multivariate analysis, PLT at 1 week after transplantation (OR: 1.07; P=0.006) and MA value (OR: 1.12; P=0.003) were independently associated with outcome. The AUROC of the model combined with MA value, MELD score, and age was 0.945 (95% CI: 0.911-0.978). CONCLUSIONS The change in primary hemostasis during the early postoperative period of adult OLT is mainly characterized by the increase of platelet count and function 14 days after transplantation. Higher PLT was associated with higher survival at 14 days after transplantation, while a higher PLT ratio was associated with survival at 3 months after transplantation. Based on comprehensive consideration, the model combined with MA value, MELD score, and age more reliably indicated the associated with early survival after transplantation.
研究表明，失代偿期肝硬化患者血小板聚集增加表明进一步失代偿和死亡的风险更高，但关于原位肝移植（OLT）患者血小板聚集功能与早期术后生存之间的关系的研究很少。我们进行了一项回顾性研究，以调查 OLT 患者围手术期全血血小板聚集情况及其与临床结局的关系。
回顾性分析 2021 年 1 月 1 日至 4 月 30 日期间接受 OLT 的成年患者的实验室检查结果。使用广义线性模型研究主要止血参数与生存之间的关系。
共纳入 256 例患者。移植前血小板计数（PLT）中位数为 61.5（39.5-106.3）×10⁹/L。MA 值中位数为 43.1（34.5-56.2）mm。移植后第 1 至 3 天，PLT 和 MA 值均呈显著下降趋势。移植后 2 周，PLT 升高至 143.0（85.0-209.0）×10⁹/L，MA 值升高至 56.7（52.2-62.7）mm。多变量分析显示，移植后 1 周时的 PLT（OR：1.07；P=0.006）和 MA 值（OR：1.12；P=0.003）与结局独立相关。结合 MA 值、MELD 评分和年龄的模型的 AUROC 为 0.945（95%CI：0.911-0.978）。
OLT 成年患者术后早期主要以血小板计数和功能增加为特征，术后 14 天血小板计数和功能增加。较高的 PLT 与移植后 14 天的较高生存率相关，而较高的 PLT 比值与移植后 3 个月的生存率相关。综合考虑，结合 MA 值、MELD 评分和年龄的模型更可靠地提示了与移植后早期生存相关的因素。
