title: Prolonged thrombocytopenia after living donor liver transplantation is a strong prognostic predictor irrespective of splenectomy: the significance of ADAMTS13 and graft function [corrected].
abstract: The precise mechanism of prolonged thrombocytopenia following living donor liver transplantation (LDLT) remains unclear. To determine risk factors associated with prolonged thrombocytopenia following LDLT, with a focus on the activity of ADAMTS13 (a disintegrin-like and metalloproteinase with thrombospondin type-1 motifs member 13) and the influence of splenectomy. Adult LDLT patients were divided into two groups on the basis of platelet counts (100 × 10(3)/μL) on POD 14: high and low platelet (HP and LP) groups. Survival analysis was performed in the 100 patients, and ADAMTS13 activity and von Willebrand factor (VWF) levels in the plasma were measured in 65 adult recipients. The 6-month survival rate was significantly lower in the LP group (n = 36) than in the HP group (n = 62) (61.1 vs. 93.5 %). ADAMTS13 activity had been significantly lower in the LP group (n = 23) than in the HP group (n = 42). The VWF/ADAMTS13 ratio was significantly higher in the LP group than in the HP group. The independent risk factors for thrombocytopenia on POD14 were preoperative AT levels and ADAMTS13 activity on POD14. TPO levels on POD14 were significantly higher in the LP group than in the HP group, while those on POD28 in the LP group were significantly decreased, despite the low platelet levels. Irrespective of splenectomy, platelet counts and ADAMTS13 activity in the LP group remained low until POD28, while VWF/ADAMTS13 ratio significantly increased until POD28. These results suggest that prolonged thrombocytopenia after LDLT was associated with not only a decrease in ADAMTS13 due to sinusoidal endothelial cell injury, but also low TPO production due to hepatocyte dysfunction, irrespective of splenectomy [corrected].
authors.affiliation: Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Nobuoka
authors.forename: Hideo
authors.initials: H
authors.lastname: Wada
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Masashi
authors.initials: M
authors.lastname: Kishiwada
authors.forename: Masanobu
authors.initials: M
authors.lastname: Usui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nobori
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
mesh_terms: D051722:ADAM Proteins / Q000378:metabolism; D000071120:ADAMTS13 Protein; D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010976:Platelet Count; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors; D013156:Splenectomy; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D013997:Time Factors
chemical_list: D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human