title: Platelet transfusion during liver transplantation is associated with increased postoperative mortality due to acute lung injury.
abstract: BACKGROUND
  Platelet transfusions have been identified as an independent risk factor for survival after orthotopic liver transplantation (OLT). In this study, we analyzed the specific causes of mortality and graft loss in relation to platelet transfusions during OLT.
  
  
  METHODS
  In a series of 449 consecutive adult patients undergoing a first OLT, the causes of patient death and graft failure were studied in patients who did or did not receive perioperative platelet transfusions.
  
  
  RESULTS
  Patient and graft survival were significantly reduced in patients who received platelet transfusions, compared with those who did not (74% vs 92%, and 69% vs 85%, respectively at 1 yr; P < 0.001). Lower survival rates in patients who received platelets were attributed to a significantly higher rate of early mortality because of acute lung injury (4.4% vs 0.4%; P = 0.004). There were no significant differences in other causes of mortality between the two groups. The main cause of graft loss in patients receiving platelets was patient death with a functioning graft.
  
  
  CONCLUSIONS
  These findings suggest that platelet transfusions are an important risk factor for mortality after OLT. The current study extends previous observations by identifying acute lung injury as the main determinant of increased mortality. The higher rate of graft loss in patients receiving platelets is related to the higher overall mortality rate and does not result from specific adverse effects of transfused platelets on the grafted liver.
authors.affiliation: Department of Surgery, Section Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Ilona T A
authors.initials: IT
authors.lastname: Pereboom
authors.forename: Marieke T
authors.initials: MT
authors.lastname: de Boer
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Haagsma
authors.forename: Herman G D
authors.initials: HG
authors.lastname: Hendriks
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000401:mortality*; D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017713:Platelet Transfusion / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome