Introduction: Patients undergoing liver transplantation (LT) due to end stage liver diseases (ESLD) have perioperative thrombocytopenia and coagulation abnormalities. The role of platelets on the prognosis of patients with LT remains unclear. We aimed to investigate the effect of platelet count at early postoperative intensive care unit (ICU) admission on transfusion requirement, allograft function and outcomes among LT recipients.
Material and Method: We retrospectively analyzed medical records of LT recipients during early postoperative period from January 2019 to January 2024. Thrombocytopenia was defined as platelet count <150 x103 /µL. LT recipients were divided into 2 groups: according to early postoperative platelet count at ICU admission <150 103 /µL was low platelet group (LPG) and ≥150 103 /µL was high platelet group (HPG).
Results: A total of 113 patients who underwent LT, 97 of them (56 males, 57.7%; 41 females, 42.3%) were included in the study. We excluded 13 patients who had missing data and 3 due to intraoperative platelet transfusion. The mean age was 14.9±20.1 years, 73 LT recipients (75.3%) were under 18 years of age. Eighty nine of the transplanted organs (91.8%) were living donors and 8 (8.2%) were cadaveric. The most common etiology was metabolic diseases (21.9%). Seventy LT recipients (72.2%) were in LPG. LPG received higher amounts of packed red blood cell suspension, fresh frozen plasma, platelet transfusion, cryoprecipitate, vitamin K and tranexamic acid than HPG during ICU stay (p<0.05). Delayed graft function (DGF) was higher in LPG than the HPG (15.7%vs 0.0%, p=0.022). There was bile leakage in 4 LT recipients and portal vein bleeding in 3, and all of them had thrombocytopenia at ICU admission. Hepatic artery and portal vein thrombosis were detected more frequently in LPG when compared to the HPG (58.3% vs 41.7% and 71.4% vs 28.6%, respectively). On ICU discharge, platelet counts were lower and total and direct bilirubin, lactate, and SOFA scores were statistically higher in LPG in comparison with the HPG. Revision surgeries and endovascular interventions were more common in LPG (71.9% vs 28.1% and 67.9% vs 32.1 respectively). The ICU mortality rate was higher in LPG in comparison to HPG (84.6% vs 15.4%).
Conclusion: Our study indicates that the incidence of thrombocytopenia is common among LT recipients during the early postoperative period. Transfusion requirements, DGF and mortality remains high among those with thrombocytopenia.