Prediction of biliary anastomotic stricture after deceased donor liver transplantation: the impact of platelet counts - a retrospective study
Takahashi K, Nagai S, Puchakayala KG, Safwan M, Gosho M, Li AY, Kane WJ, Singh PL, Rizzari MD, Collins KM, Yoshida A, Abouljoud MS, and Schnickel GT. Prediction of biliary anastomotic stricture after deceased donor liver transplantation: The impact of platelet counts. Transpl Int 2017; 30(10):1032-1040.
Biliary stricture is a common cause of morbidity after liver transplantation (LT). This study aimed to determine the risk factors for post-transplant biliary anastomotic strictures (BAS), focusing on perioperative platelet counts. We enrolled 771 consecutive recipients who underwent ABO-identical/compatible deceased donor LT with duct-to-duct biliary reconstruction from January 2000 to June 2012. BAS was identified in 142 cases. The median time for stricture development was 176 days. Preoperative and postoperative platelet counts within 5 days after LT were significantly lower in patients with BAS than those without BAS. Using cutoff values acquired by the receiver operating characteristic curve analysis, persistent postoperative thrombocytopenia was defined as platelet counts <41 >× 1000/μl and <53 >× 1000/μl on postoperative day (POD) 3 and POD 5, respectively. Multivariate analysis indicated persistent postoperative thrombocytopenia (OR = 2.38) was the only independent risk factor for BAS. No significant associations were observed in terms of donor and surgical factors. Multivariate analysis demonstrated estimated blood loss (OR = 1.01, per 100 ml) was an independent contributing factor for persistent postoperative thrombocytopenia. We demonstrated low platelet count was associated with progression of post-transplant BAS. Minimizing intraoperative blood loss potentially contributes to maintain post-transplant platelet count, which may reduce incidence of BAS.
Medical Subject Headings
Adolescent; Adult; Aged; Bile Duct Diseases; Constriction, Pathologic; Female; Humans; Liver Transplantation; Male; Middle Aged; Platelet Count; Postoperative Complications; Retrospective Studies; Thrombocytopenia; Young Adult