title: Dysfunction in Patients With Small-for-Size Grafts After Living Donor Liver Transplantation.
abstract: The relationship between postoperative percentage fall of platelet (PLT) counts and graft dysfunction after living donor liver transplantation (LDLT) in recipients with small-for-size (SFS) graft has not been fully evaluated. We retrospectively studied 50 adult-to-adult LDLT recipients with a graft-to-recipient weight ratio of <0.8% between 1999 and 2011. Graft dysfunction was defined as the presence of hyperbilirubinemia, coagulopathy, or ascites on 3 consecutive days during the first postoperative week. Each clinical sign of dysfunction was assigned 1 point. Postoperative percentage fall in PLT counts, graft dysfunction score, and postoperative complications according to the Clavien-Dindo classification were investigated. Overall, 31 patients (62%) exhibited a PLT count fall of more than 50%, and 19 (38%) patients exhibited a PLT count fall of less than 50% at postoperative day (POD) 3. Receiver operating characteristic curve analysis indicated that at POD 3, the cutoff value of PLT count fall was 56% for a graft dysfunction score of 2 or 3 (sensitivity, 70%; specificity, 63.3%). Fourteen of 20 patients (70%) with a dysfunction score of 2 or 3 and 11 of 30 patients (37%) with a dysfunction score of 0 or 1 showed a fall in PLT count >56% at POD 3 (P = 0.021). Grade 2 to 5 complications were more observed in patients with a dysfunction score of 2 or 3 than in patients with a dysfunction score of 0 or 1 (P < 0.001). The fall of PLT count at POD 3 >56% is an ominous sign that can predict the graft dysfunction after LDLT in recipients with SFS graft.
authors.affiliation: 1 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Shozo
authors.initials: S
authors.lastname: Mori
authors.forename: Min-Su
authors.initials: MS
authors.lastname: Park
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Kim
authors.forename: Youngrok
authors.initials: Y
authors.lastname: Choi
authors.forename: Geun
authors.initials: G
authors.lastname: Hong
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D055031:Primary Graft Dysfunction / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: Graft dysfunction; Portal hypertension; Small-for-size graft; Small-for-size syndrome; Thrombocytopenia