Low Platelet Counts and Prolonged Prothrombin Time Early After Operation Predict the 90 Days Morbidity and Mortality in Living-donor Liver Transplantation
OBJECTIVE:The aim of the study was to investigate the association between platelet count/prothrombin time early after transplant and short-term outcomes among living-donor liver transplant (LDLT) recipients. BACKGROUND:Postoperative platelet count and prothrombin time-international normalized ratio...
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| Veröffentlicht in: | Annals of surgery 2017-01, Vol.265 (1), p.166-172 |
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| container_title | Annals of surgery |
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| creator | Akamatsu, Nobuhisa Sugawara, Yasuhiko Kanako, Junichi Arita, Junichi Sakamoto, Yoshihiro Hasegawa, Kiyoshi Kokudo, Norihiro |
| description | OBJECTIVE:The aim of the study was to investigate the association between platelet count/prothrombin time early after transplant and short-term outcomes among living-donor liver transplant (LDLT) recipients.
BACKGROUND:Postoperative platelet count and prothrombin time-international normalized ratio (PT-INR) were critical biomarkers in LDLT.
METHODS:The study participants consisted of 445 initial LDLT recipients, and perioperative variables, including platelet count and PT-INR, were assessed for their association with severe complications (Clavien-Dindo classification grade IIIb/IV) and mortality within 90 days after operation.
RESULTS:Severe complications and operative mortality occurred in 161 (36%) and 23 patients (5%), respectively. Cox regression analysis revealed that a high body mass index [hazard ratio (HR) 1.2; 95% confidence interval (CI), 1.1–1.4; P = 0.004] and low platelet count on postoperative day (POD)3 (HR 0.88; 95% CI, 0.57–0.97; P |
| doi_str_mv | 10.1097/SLA.0000000000001634 |
| format | Article |
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BACKGROUND:Postoperative platelet count and prothrombin time-international normalized ratio (PT-INR) were critical biomarkers in LDLT.
METHODS:The study participants consisted of 445 initial LDLT recipients, and perioperative variables, including platelet count and PT-INR, were assessed for their association with severe complications (Clavien-Dindo classification grade IIIb/IV) and mortality within 90 days after operation.
RESULTS:Severe complications and operative mortality occurred in 161 (36%) and 23 patients (5%), respectively. Cox regression analysis revealed that a high body mass index [hazard ratio (HR) 1.2; 95% confidence interval (CI), 1.1–1.4; P = 0.004] and low platelet count on postoperative day (POD)3 (HR 0.88; 95% CI, 0.57–0.97; P < 0.001) were independent predictors for grade IIIb/IV complications after LDLT, whereas high PT-INR on POD5 (HR 1.1; 95% CI, 1.1–1.3; P = 0.021) was the only independent factor for operative mortality. In addtion, the progonostic scoring with low platelet count (<50 × 10/L) and prolonged prothrombin time (PT-INR >1.6) within POD5, 1 point for each, was demonstrated to be useful in predicting the development of Clavien-Dindo grade IIIb/IV/V complications after LDLT (30% for score 0, 46% for score 1, and 72% for score 20 vs 1, P = 0.004; 0 vs 2, P < 0.001; 1 vs 2, P = 0.002).
CONCLUSIONS:PT-INR above 1.6 and platelet count below 50 × 10/L within POD5 were useful predictors of mortality and severe complications after LDLT.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000001634</identifier><identifier>PMID: 28009742</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Female ; Follow-Up Studies ; Humans ; International Normalized Ratio ; Kaplan-Meier Estimate ; Liver Transplantation - mortality ; Living Donors ; Male ; Middle Aged ; Platelet Count ; Postoperative Complications - blood ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Prognosis ; Proportional Hazards Models ; Prothrombin Time ; Retrospective Studies ; Severity of Illness Index</subject><ispartof>Annals of surgery, 2017-01, Vol.265 (1), p.166-172</ispartof><rights>Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4187-781418f7015d4a561a736031473a0606fea4d486d042a0217db2e0b051add3a73</citedby><cites>FETCH-LOGICAL-c4187-781418f7015d4a561a736031473a0606fea4d486d042a0217db2e0b051add3a73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28009742$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Akamatsu, Nobuhisa</creatorcontrib><creatorcontrib>Sugawara, Yasuhiko</creatorcontrib><creatorcontrib>Kanako, Junichi</creatorcontrib><creatorcontrib>Arita, Junichi</creatorcontrib><creatorcontrib>Sakamoto, Yoshihiro</creatorcontrib><creatorcontrib>Hasegawa, Kiyoshi</creatorcontrib><creatorcontrib>Kokudo, Norihiro</creatorcontrib><title>Low Platelet Counts and Prolonged Prothrombin Time Early After Operation Predict the 90 Days Morbidity and Mortality in Living-donor Liver Transplantation</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>OBJECTIVE:The aim of the study was to investigate the association between platelet count/prothrombin time early after transplant and short-term outcomes among living-donor liver transplant (LDLT) recipients.
BACKGROUND:Postoperative platelet count and prothrombin time-international normalized ratio (PT-INR) were critical biomarkers in LDLT.
METHODS:The study participants consisted of 445 initial LDLT recipients, and perioperative variables, including platelet count and PT-INR, were assessed for their association with severe complications (Clavien-Dindo classification grade IIIb/IV) and mortality within 90 days after operation.
RESULTS:Severe complications and operative mortality occurred in 161 (36%) and 23 patients (5%), respectively. Cox regression analysis revealed that a high body mass index [hazard ratio (HR) 1.2; 95% confidence interval (CI), 1.1–1.4; P = 0.004] and low platelet count on postoperative day (POD)3 (HR 0.88; 95% CI, 0.57–0.97; P < 0.001) were independent predictors for grade IIIb/IV complications after LDLT, whereas high PT-INR on POD5 (HR 1.1; 95% CI, 1.1–1.3; P = 0.021) was the only independent factor for operative mortality. In addtion, the progonostic scoring with low platelet count (<50 × 10/L) and prolonged prothrombin time (PT-INR >1.6) within POD5, 1 point for each, was demonstrated to be useful in predicting the development of Clavien-Dindo grade IIIb/IV/V complications after LDLT (30% for score 0, 46% for score 1, and 72% for score 20 vs 1, P = 0.004; 0 vs 2, P < 0.001; 1 vs 2, P = 0.002).
CONCLUSIONS:PT-INR above 1.6 and platelet count below 50 × 10/L within POD5 were useful predictors of mortality and severe complications after LDLT.</description><subject>Adult</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Kaplan-Meier Estimate</subject><subject>Liver Transplantation - mortality</subject><subject>Living Donors</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Platelet Count</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prothrombin Time</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkdtuEzEURS1ERUPhDxDyIy9TfJux8xiF0iINaiXC88gTn2kMHjvYHqL8Sr-2TlIuqiXreFv7LF82Qu8ouaRkLj9-axeX5L9BGy5eoBmtmaooFeQlmpVdXok5Z-fodUo_ikcoIl-hc6ZIQQg2Qw9t2OE7pzM4yHgZJp8T1t7guxhc8PdwXOVNDGNvPV7ZEfCVjm6PF0OGiG-3EHW2wRcbGLvOOG8Azwn-pPcJfw2xt8bm_RFZVNbuoAqptb-tv69M8CEeRGGtovZp67TPR-IbdDZol-DtU71A3z9frZY3VXt7_WW5aKu1oEpWUtFSB0lobYSuG6olbwinQnJNGtIMoIURqjFEME0YlaZnQHpSU20ML-YL9OHE3cbwa4KUu9GmNbhyEQhT6qiqmVQNp6pYxcm6jiGlCEO3jXbUcd9R0h1S6Uoq3fNUStv7pxOmfgTzt-lPDP-4u-DKr6afbtpB7DagXd6ceE2tKkZoeWYRVZlM8keI2pfu</recordid><startdate>201701</startdate><enddate>201701</enddate><creator>Akamatsu, Nobuhisa</creator><creator>Sugawara, Yasuhiko</creator><creator>Kanako, Junichi</creator><creator>Arita, Junichi</creator><creator>Sakamoto, Yoshihiro</creator><creator>Hasegawa, Kiyoshi</creator><creator>Kokudo, Norihiro</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201701</creationdate><title>Low Platelet Counts and Prolonged Prothrombin Time Early After Operation Predict the 90 Days Morbidity and Mortality in Living-donor Liver Transplantation</title><author>Akamatsu, Nobuhisa ; Sugawara, Yasuhiko ; Kanako, Junichi ; Arita, Junichi ; Sakamoto, Yoshihiro ; Hasegawa, Kiyoshi ; Kokudo, Norihiro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4187-781418f7015d4a561a736031473a0606fea4d486d042a0217db2e0b051add3a73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Kaplan-Meier Estimate</topic><topic>Liver Transplantation - mortality</topic><topic>Living Donors</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Platelet Count</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prothrombin Time</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Akamatsu, Nobuhisa</creatorcontrib><creatorcontrib>Sugawara, Yasuhiko</creatorcontrib><creatorcontrib>Kanako, Junichi</creatorcontrib><creatorcontrib>Arita, Junichi</creatorcontrib><creatorcontrib>Sakamoto, Yoshihiro</creatorcontrib><creatorcontrib>Hasegawa, Kiyoshi</creatorcontrib><creatorcontrib>Kokudo, Norihiro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Akamatsu, Nobuhisa</au><au>Sugawara, Yasuhiko</au><au>Kanako, Junichi</au><au>Arita, Junichi</au><au>Sakamoto, Yoshihiro</au><au>Hasegawa, Kiyoshi</au><au>Kokudo, Norihiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low Platelet Counts and Prolonged Prothrombin Time Early After Operation Predict the 90 Days Morbidity and Mortality in Living-donor Liver Transplantation</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2017-01</date><risdate>2017</risdate><volume>265</volume><issue>1</issue><spage>166</spage><epage>172</epage><pages>166-172</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:The aim of the study was to investigate the association between platelet count/prothrombin time early after transplant and short-term outcomes among living-donor liver transplant (LDLT) recipients.
BACKGROUND:Postoperative platelet count and prothrombin time-international normalized ratio (PT-INR) were critical biomarkers in LDLT.
METHODS:The study participants consisted of 445 initial LDLT recipients, and perioperative variables, including platelet count and PT-INR, were assessed for their association with severe complications (Clavien-Dindo classification grade IIIb/IV) and mortality within 90 days after operation.
RESULTS:Severe complications and operative mortality occurred in 161 (36%) and 23 patients (5%), respectively. Cox regression analysis revealed that a high body mass index [hazard ratio (HR) 1.2; 95% confidence interval (CI), 1.1–1.4; P = 0.004] and low platelet count on postoperative day (POD)3 (HR 0.88; 95% CI, 0.57–0.97; P < 0.001) were independent predictors for grade IIIb/IV complications after LDLT, whereas high PT-INR on POD5 (HR 1.1; 95% CI, 1.1–1.3; P = 0.021) was the only independent factor for operative mortality. In addtion, the progonostic scoring with low platelet count (<50 × 10/L) and prolonged prothrombin time (PT-INR >1.6) within POD5, 1 point for each, was demonstrated to be useful in predicting the development of Clavien-Dindo grade IIIb/IV/V complications after LDLT (30% for score 0, 46% for score 1, and 72% for score 20 vs 1, P = 0.004; 0 vs 2, P < 0.001; 1 vs 2, P = 0.002).
CONCLUSIONS:PT-INR above 1.6 and platelet count below 50 × 10/L within POD5 were useful predictors of mortality and severe complications after LDLT.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>28009742</pmid><doi>10.1097/SLA.0000000000001634</doi><tpages>7</tpages></addata></record> |
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| ispartof | Annals of surgery, 2017-01, Vol.265 (1), p.166-172 |
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| source | MEDLINE; PubMed Central; Journals@Ovid Complete |
| subjects | Adult Female Follow-Up Studies Humans International Normalized Ratio Kaplan-Meier Estimate Liver Transplantation - mortality Living Donors Male Middle Aged Platelet Count Postoperative Complications - blood Postoperative Complications - diagnosis Postoperative Complications - epidemiology Prognosis Proportional Hazards Models Prothrombin Time Retrospective Studies Severity of Illness Index |
| title | Low Platelet Counts and Prolonged Prothrombin Time Early After Operation Predict the 90 Days Morbidity and Mortality in Living-donor Liver Transplantation |
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