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Shigeru Marubashi, MD, PhD; Keizo Dono, MD, PhD; Atsushi Miyamoto, MD, PhD; Yutaka Takeda, MD, PhD; Hiroaki Nagano, MD, PhD; Koji Umeshita, MD, PhD; Morito Monden, MD, PhD

Arch Surg. 2007;142(11):1054-1058.

Hypothesis  Perioperative variables, including portal venous pressure (PVP) and graft size, can predict thrombocytopenia after living donor liver transplant (LDLT).

Design  Retrospective analysis.

Setting  University hospital.

Patients  Forty-five adult patients with liver cirrhosis who underwent LDLT without splenectomy (n = 38) or with simultaneous splenectomy (n = 7).

Main Outcome Measures  Preoperative and postoperative platelet counts and perioperative variables of recipient age, preoperative Model for End-Stage Liver Disease score, donor age, graft volume to standard liver volume ratio, PVP, cold and warm ischemia times, blood loss, and surgical complications.

Results  In the 38 recipients who did not undergo splenectomy, there was a strong correlation between PVP at the completion of the transplant and the platelet count (at 14 and 28 days and at 3 months). A high PVP ( 25 mm Hg) correlated with posttransplant thrombocytopenia, as did a small graft. Patients undergoing a simultaneous splenectomy had sufficient platelet levels at each measurement, irrespective of the graft volume.

Conclusions  Portal venous pressure and graft size were associated with posttransplant thrombocytopenia. Splenectomy is an option in cases with a high PVP or a small graft, especially for patients receiving postoperative interferon therapy for hepatitis C virus.

Author Affiliations: Department of Surgery and Clinical Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.

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Arch Surg. 2007;142(11):1058.
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