Dependence of platelet function on underlying liver disease in orthotopic liver transplantation.
OBJECTIVE
The purpose of the present study was to explore the platelet function during the perioperative period of orthotopic liver transplantation (OLT) due to the underlying liver disease.


METHODS
The blood coagulation parameters, platelet surface markers and the determination of platelet aggregation were analyzed in 34 patients who underwent OLT. Blood samples were drawn preoperatively, anhepatic, 10 min and 1 hour after reperfusion, 1 day, 3 and 7 days postoperatively. Conventional coagulation screens, thrombopoietin (TPO) serum levels, P-selectin, GPIIb/IIIa and GPIb binding sites on the surface of platelets as evaluated by flow cytometry and platelet aggregation response were measured.


RESULTS
Coagulation factors, maximum aggregation and rate of aggregation were significantly different before transplantation due to the underlying liver disease. Further we found a markedly depressed GPIIb/IIIa and P-selectin expression and a reduced rate of aggregation in all patients throughout the study. In contrast maximum aggregation of platelets was restored on the third day after reperfusion without intergroup differences and almost comparable to healthy controls. An inverse correlation was found between peripheral platelet count pre-transplantation and peak TPO concentrations one weak post-transplantation.


CONCLUSIONS
In the entire process of OLT, coagulation factors, maximum aggregation and rate of platelet aggregation depend on the surgical phases during transplantation and on the underlying liver disease. The data obtained in this study might contribute to a better understanding of the pathophysiology and assessment of bleeding risk in OLT.
Jüttner
Björn
B
Department of Anesthesiology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany. juettner.bjoern@mh-hannover.de
Brock
Jeanette
J
Weissig
Annette
A
Becker
Thomas
T
Studzinski
Arthur
A
Osthaus
Wilhelm A
WA
Bornscheuer
Albrecht
A
Scheinichen
Dirk
D
D000328:Adult; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000378:metabolism; D001792:Blood Platelets / Q000502:physiology*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000096:biosynthesis; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000096:biosynthesis
D001779:Blood Coagulation Factors; D019007:P-Selectin; D019039:Platelet Glycoprotein GPIIb-IIIa Complex