Abstract
In patients presenting for liver transplantation, increased platelet aggregation as well as thrombocytopenia have been demonstrated, but bedside assays have not been investigated. We compared platelet aggregation in liver transplantation patients and control surgical patients using impedance aggregometry. We hypothesized that platelet activity is not altered during liver transplantation. After the allowance of the ethics committee, platelet aggregation was determined using impedance aggregometry with the activators ristocetin, adenosine diphosphate (ADP), arachidonic acid, collagen, and thrombin receptor-activating peptide (TRAP) in liver transplantation patients at four time points (start of surgery, anhepatic phase, reperfusion, end of surgery) and in control surgical patients. Moreover, platelet count was determined using a Coulter counter. To compensate for the thrombocytopenia often present in patients presenting for liver transplantation, the ratio between impedance aggregometry finding and platelet count was used. For statistical evaluation, the t-test or the Mann–Whitney U-test were used, as appropriate. Platelet aggregation ratio showed a 3.1-fold increase in liver transplantation patients (n = 37) in comparison to control surgical patients (n = 10) when ristocetin was used as the activator (p = 0.001). Moreover, an approximately twofold increase of ADP-, arachidonic acid-, collagen-, and TRAP-induced platelet aggregation ratio was determined. Platelet aggregation normalized at the end of the transplantation procedure. Impedance aggregometry revealed a markedly increased platelet aggregation in some liver transplantation patients and might be suitable to guide platelet transfusion and antiplatelet therapy.
Highlights
In patients with end-stage liver failure presenting for liver transplantation, numerous changes in hemostasis and platelet function can be observed [1]
The method is capable to measure the aggregation of platelets on electrodes in whole-blood samples induced by adenosine diphosphate (ADP), collagen, arachidonic acid, thrombin receptor-activating peptide (TRAP), and ristocetin to monitor the effects of antiplatelet agents as well as von Willebrand factor activity
In contrast to conventional Born aggregometry, impedance aggregometry samples are not corrected for platelet count, and the effect of thrombocytopenia in end-stage liver disease on the readings has to be addressed by the calculation of the ratio between impedance aggregometry findings and platelet count
Summary
In patients with end-stage liver failure presenting for liver transplantation, numerous changes in hemostasis and platelet function can be observed [1]. In contrast to conventional Born aggregometry, impedance aggregometry samples are not corrected for platelet count, and the effect of thrombocytopenia in end-stage liver disease on the readings has to be addressed by the calculation of the ratio between impedance aggregometry findings and platelet count. It was the aim of the present study to investigate platelet function with the multiplateTM device during liver transplantation and in control patients and to evaluate the correction of impedance aggregation findings for differences in platelet count
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