Direct evidence for an increase in thrombopoiesis after liver transplantation

Stiegler,; Stohlawetz,; Peck‐Radosavljevic,; Jilma, Bernd; Pidlich,; Wichlas,; Hocker,; Panzer,

doi:10.1046/j.1365-2362.1998.00348.x

Cited by 23 publications

(22 citation statements)

References 28 publications

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“…These data suggest that concentration of serum TPO is, to some degree, dependent on the capacity of the liver to produce this protein. Since liver function in patients who underwent orthotopic liver transplantation seemed to be severely impaired [20][21][22][23], the discrepancy between the results of this study and ours may derive from difference in severity of liver dysfunction.…”

Section: Discussioncontrasting

confidence: 89%

“…Hepatoma cells also express TPO mRNA [18,19]. Indeed, it is reported that serum TPO was low in liver cirrhosis but, however, it was increased after orthotopic liver transplantation, which was followed by an increase in platelet count [20][21][22][23]. These observations may support the hypothesis that impaired production of TPO in liver disease contributes to thrombocytopenia associated with chronic viral hepatitis.…”

Section: Introductionmentioning

confidence: 83%

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Thrombopoietin levels in serum and liver tissue in patients with chronic viral hepatitis and hepatocellular carcinoma

Okubo¹,

Shiota²,

Kawasaki³

2000

Clinical Science

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Thrombocytopenia in liver diseases is considered to be due to splenic platelet pooling and accelerated destruction. Since thrombopoietin (TPO), a regulator of thrombopoiesis, is produced mainly in the liver, decreased production of TPO may account for thrombocytopenia in liver diseases. To address this issue, we measured serum TPO, using a sensitive sandwich ELISA, in 108 patients with chronic viral hepatitis, which included chronic hepatitis (CH) and liver cirrhosis (LC), and hepatocellular carcinoma (HCC), and in 29 normal controls. TPO mRNA in 78 liver samples was examined by reverse transcription (RT)-PCR. Platelet counts in CH, LC, HCC and controls were 176 +/- 15 x 10(9)/l, 81 +/- 8 x 10(9)/l, 99 +/- 7 x 10(9)/l and 234 +/- 9 x 10(9)/l respectively. Serum TPO levels in CH, LC and HCC were 2.79 +/- 0.4 fmol/ml, 1.49 +/- 0.2 fmol/ml and 1.97 +/- 0.2 fmol/ml, and were higher than those of controls. Serum TPO levels were positively correlated with prothrombin time and serum albumin (P < 0.05, in each case), and negatively correlated with Indocyanine Green test and Pugh score (P < 0.01 and P < 0.05 respectively). However, RT-PCR and immunohistochemistry showed that expression of TPO mRNA and protein were similar in the different liver diseases, suggesting that serum TPO is a reflection of the total mass of functional liver. Platelet counts were negatively correlated with spleen index, but not with serum TPO. These results suggest that thrombocytopenia in liver disease is not directly associated with serum TPO but is associated with hypersplenism.

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Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 83%

Thrombopoietin levels in serum and liver tissue in patients with chronic viral hepatitis and hepatocellular carcinoma

Okubo¹,

Shiota²,

Kawasaki³

2000

Clinical Science

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“…Cirrhotic patients have a lack of TPO relative to their platelet counts, as evidenced by the approximately 10-fold higher serum TPO concentration in similarly thrombocytopenic patients with aplastic anemia. 10,20,21 In addition, Martin et al 9 and Stiegler et al 22 showed that circulating TPO increases in adult patients with cirrhosis after orthotopic liver transplantation, reaching a maximum 5 to 6 days after surgery. This increase has been related to the potential of the transplanted liver to produce TPO.…”

Section: Discussionmentioning

confidence: 99%

Hepatic thrombopoietin mRNA levels in acute and chronic liver failure of childhood

Wolber¹,

Ganschow

Burdelski

et al. 1999

Hepatology

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The liver is the main production site of the hormone thrombopoietin (TPO), the major regulator of megakaryopoiesis. To investigate the role of an impaired TPO gene expression in the pathogenesis of thrombocytopenia in pediatric patients suffering from liver failure, we measured hepatic TPO mRNA in children with acute or chronic end-stage liver disease undergoing orthotopic liver transplantation. Tissue samples for RNA extraction were obtained from 12 children with compensated cirrhosis (CC), 22 children with decompensated cirrhosis (DC), and 9 children with acute liver failure (ALF). The glycoprotein hormone, thrombopoietin (TPO), is the major regulator of megakaryopoiesis and platelet production. 1,2 Northern blot analyses have demonstrated that TPO mRNA is expressed predominantly in liver, and to a minor degree, in kidney, spleen, and brain. 3,4 A recent report from this laboratory has shown that hepatic TPO mRNA accounts for 94% of the total in the perinatal period. 5 In situ hybridization studies have localized TPO mRNA in parenchymal cells of the human 6 and murine 7 liver. Hepatocytes appear to produce TPO at a constant rate. The plasma concentration of the hormone is regulated by the degree of receptor-mediated binding and degradation of TPO by platelets and, in all likelihood, megakaryocytes.

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“…For rescuing patients from these disorders, direct removal of spleen by splenectomy (Puttini et al 1979; Soper & Rikkers 1982), volume reduction of spleen by partial splenic embolization (Stiegler et al 1998; Sangro et al 1993; Herrero et al 1997), or portal decompression by transjuglar intrahepatic portosystemic shunt (Alvarez et al 1996; Pursnani et al 1997) are performed as the effective methods in these days. However, some controversial reports have noted that thrombocytopenia may persist even after splenectomy or partial decompression (Pradella et al 2011; Sanyal et al 1996; Gschwantler et al 1999).…”

Section: Introductionmentioning

confidence: 99%

Long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation-various dynamics depending on etiology

et al. 2013

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BackgroundHypersplenism is a common complication in cirrhotic patients, and liver transplantation would be one of the effective treatments. However, detailed dynamics, especially over a long term, are not fully understood. We investigated the long-term dynamics of hematological data and spleen volumes, as well as their correlation in cirrhotic patients who underwent liver transplantation.Patients and methodsWe studied 53 cirrhotic patients who underwent liver transplantation at our institute and followed for more than 1 year. Hematological data were collected from medical records, while spleen volumes were determined by CT volumetry at 0, 1, 3, 6, 12, 24, 36, 48, 60 postoperative months (POM).Results(1) Platelet (Plt) and hemoglobin (Hb) levels were gradually increased up to 18 and 10 POM, respectively, in contrast with white blood cells (WBC), which remained mostly unchanged from pretransplantation levels. (2) Spleen volume was sharply decreased in the first POM, then showed a slower but steady decline up to 48 POM. (3) Spleen volume was significantly correlated with hematological data, though the levels were generally weak (Plt: r = 0.433, p < 0.001; Hb: r = 0.233, p < 0.001; WBC: r = 0.217, p = 0.001). (4) Spleen volume was strongly correlated with all hematological parameters in HBV patients (Plt: r = 0.617, p < 0.0001; Hb: r = 0.401, p < 0.001; WBC: r = 0.387, p < 0.001), in contrast with that in other etiologies, which had generally weak correlations though some were statistically significant.ConclusionsWe investigated the long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation. Unique dynamics and correlations between them were found among the different etiologies investigated.

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Direct evidence for an increase in thrombopoiesis after liver transplantation

Cited by 23 publications

References 28 publications

Thrombopoietin levels in serum and liver tissue in patients with chronic viral hepatitis and hepatocellular carcinoma

Thrombopoietin levels in serum and liver tissue in patients with chronic viral hepatitis and hepatocellular carcinoma

Hepatic thrombopoietin mRNA levels in acute and chronic liver failure of childhood

Long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation-various dynamics depending on etiology

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