Low Platelet Counts After Liver Transplantation: Validation of the 60-5 Criterion

Abstract

Background: Platelets play a critical role in hepatic ischemia-reperfusion injury and regeneration. In a single-centre cohort of liver transplanted patients (derivation cohort), platelet counts <60x109/L at postoperative day 5 (POD5) (the 60-5 criterion) were shown to be an independent predicting factor for severe postoperative complications and early graft and patient survival. The aim of this study was to validate those findings using a validation cohort containing prospective data. Methods: The validation cohort comprised prospectively collected data on donors, recipients, perioperative laboratory values, graft function, complications and survival from 285 liver transplantations between 2008 and 2014. The primary outcome was grade IIIb/IV complications, secondary outcomes were graft and patient survival. Results: Mean patient and donor ages were 57 ±11.6 and 51 ±18.3 years respectively. The average MELD score was 18 ± 10.6. Patients with POD5 platelet counts <60 x109/L had higher rates of severe (grade IIIb/IV) complications [27.8% versus 16.8%, odds ratio (OR) 1.9 (95% CI 1.1-3.5), p<0.05] and worse 90-day mortality [6.1% versus 1.3%, OR 5.0 (95% CI 1.0-24.6), p<0.05]. The 1-, 3-, and 5-year graft and overall survival rates were similar in both groups. Conclusion: This study validates the 60-5 criterion as a predictor of severe complications and 90-day mortality after liver transplantation. These findings may help in developing protective strategies or interventions early after liver transplantation in high-risk patients.