Impact of cold ischemia time on thrombocytopenia after liver transplantation

Abstract

Purpose: Thrombocytopenia is one of the most frequent haematological disorders of end-stage liver disease and can also occur in the early post-transplant period, with an increased risk of bleeding and the need for blood transfusions.Thrombocytopenia can be due to the increased consumption of platelets, as in inflammation.During the transplant, the graft ischemia/reperfusion can cause injuries of the liver tissue, with the development of local inflammatory processes.The aim of our work is to find a relationship between the cold ischemic time (CIT) of the graft and the degree of thrombocytopenia in the early post-transplant period. Methods: All patients undergoing liver transplant performed in our Center from November 2006 to July 2020 were enrolled. The use of the perfusion machine was considered an exclusion factor. Only grafts from brain-dead (DBD) donors were included. CIT and the nadir platelet (PLT) count recorded in the early post-transplant period were analyzed. In addition, the following recipient parameters were considered: age, gender, body mass index (BMI), model for end stage liver disease (MELD) score, indication for transplant, pre-transplant haemoglobin (Hb) concentration, pre-transplant platelet count, presence of ascites at transplant, red blood cell transfusion, PLT transfusion, fresh frozen plasma transfusion.Categorical variables were compared with the chi-square test, while continuous variables were analyzed with Student's T test. A regression analysis was performed to find a relationship between the length of CIT and the degree of thrombocytopenia. Results: The population analyzed consisted of 359 liver recipients, made up of 71.6% male patients, with a median age of 58, a median BMI of 25.5 and a median MELD of 22.Ascites was found in 56.8% of cases. The median pre-transplant values of PLT and Hb were 71x10ˆ9/l and 10.4 g/dl, respectively.The median CIT was 480 minutes while the median nadir of post-transplant PLT was 28 x10ˆ9/l.The regression analysis of the two former parameters showed a statistically significant relationship (p=0.016), with an inverse proportion. Conclusions: Our data, in addition to underlining the need for minimize the duration of graft ischemia, prove that the length of CIT can predict an increased risk of thrombocytopenia. Post-transplant assessment is based on thrombocytopenia, but our results demonstrate a crucial importance of CIT in the evaluation of the liver recipient.