Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation

Amygdalos, Iakovos; Czigány, Zoltán; Bednarsch, Jan; Boecker, Joerg; Santana, Daniel Antonio Morales; Meister, Franziska; Massen, Jelena von der; Liu, Wenjia; Strnad, Pavel; Neumann, Ulf; Lurje, Georg

doi:10.1007/s11605-019-04337-3

Cited by 16 publications

(22 citation statements)

References 42 publications

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“…There are many previous studies that peripheral inflammatory cell-based combination scores like NLR, LMR and PLR have a promising prognostic values in predicting patient survival for HCC in various treatment modalities [55][56][57][58]. In addition, several reports focusing on individual cell types to evaluated the prognostic value in predicting survival for HCC have been published, but these studies investigated patients who performed specific treatment [59,60]. To our knowledge, until recently few studies have reported the prognostic value of pretreatment individual inflammatory cell alone in HCC regardless of treatment modalities.…”

Section: Discussionmentioning

confidence: 99%

Pretreatment peripheral neutrophils, lymphocytes and monocytes predict long-term survival in hepatocellular carcinoma

et al. 2020

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Background Hepatocellular carcinoma (HCC) is an inflammation-related cancer, where nonresolving inflammation contributes to its development and progression. Peripheral inflammatory cells have been shown to be associated with the prognosis of various types of cancer. The present study investigated the utility of pretreatment peripheral inflammatory cells in the prognosis of patients with HCC. Methods We retrospectively analyzed data regarding peripheral inflammatory cell, and patient and tumor characteristics from patients with HCC who were diagnosed between November 2008 and March 2018. Baseline data, including peripheral inflammatory cell counts, were recorded before treatment. The relationships between overall survival (OS) and study variables were assessed. Results A total of 1681 patients who were diagnosed with HCC were included. In univariate and multivariate analyses, individual neutrophil, lymphocyte and monocyte cell counts were found as independent indicators of poor OS. High neutrophil (≥3100 × 106/L) and, monocyte (≥470 × 106/L) counts and low lymphocyte counts (< 1640 × 106/L) significantly associated with reduced OS (p < 0.05). Neutrophil and, monocyte cell counts rose and lymphocyte counts decreased in association with advancing the Barcelona Clinic Liver Cancer stage (P < 0.001). Conclusions Pretreatment peripheral neutrophils, lymphocytes, and monocytes are independently associated with outcomes of patients with HCC. These cells provides a noninvasive, low-cost, easy, and reproducible biomarker that can be used in routine clinical practice to predict the prognosis of patients with HCC.

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Section: Discussionmentioning

confidence: 99%

Pretreatment peripheral neutrophils, lymphocytes and monocytes predict long-term survival in hepatocellular carcinoma

et al. 2020

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“…Complications were stratified according to CD and CCI. Definitions of EAD, MEAF, renal failure and other relevant variables have been previously described [10,37,40], as have calculations of the length of ICU and hospital stay and perioperative transfusions [5,8,41]. Risk‐assessment scores used in this study (such as MELD, BAR and SOFT) have already been described and validated in various cohorts [2,6,7,9].…”

Section: Methodsmentioning

confidence: 99%

“…Risk‐assessment scores used in this study (such as MELD, BAR and SOFT) have already been described and validated in various cohorts [2,6,7,9]. Finally, hospitalization costs were estimated using a validated cost‐estimation tool, as previously reported [5,42].…”

Section: Methodsmentioning

confidence: 99%

“…Over the last 60 years, orthotopic liver transplantation (OLT) evolved from an experimental technique to the gold standard treatment for end‐stage liver disease [1–3] with more than 30 000 liver transplantations carried out worldwide in 2018 [4]. A combination of factors enabled the successful clinical implementation of OLT, including a better understanding of hepatic pathophysiology and immunology, advances in surgical techniques and perioperative management, as well as refinement of patient selection criteria [2,5–7].…”

Section: Introductionmentioning

confidence: 99%

“…Newer scores have also been developed, such as the Liver Graft Assessment Following Transplantation (L‐GrAFT) [13] and Early Allograft Failure Simplified Estimation (EASE)[14] scores, which focus on early allograft dysfunction. Some workgroups have created simplified scores (such as Kong et al., who included recipient age, creatinine, bilirubin and albumin (Alb) [15]) or focused on individual parameters, such as post‐operative platelet counts [5], body mass index (BMI) [16], recipient blood type [17] or recipient and donor gender as prognostic markers [18].…”

Section: Introductionmentioning

confidence: 99%

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Clinical value and limitations of the preoperative C‐reactive‐protein‐to‐albumin ratio in predicting post‐operative morbidity and mortality after deceased‐donor liver transplantation: a retrospective single‐centre study

et al. 2021

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Summary Liver transplantation is still associated with a high risk of severe complications and post‐operative mortality. This study examines the predictive value of the preoperative C‐reactive‐protein‐to‐albumin ratio (CAR) regarding perioperative morbidity and mortality in deceased‐donor liver transplantation (DDLT) recipients. In total, 390 DDLT recipients between 05/2010 and 03/2020 were eligible. Predictive abilities of CAR were examined through receiver operating characteristic curve (ROC) analyses. Groups were compared using parametric and non‐parametric tests as appropriate. Independent risk factors for morbidity and mortality were identified using uni‐ and multivariable logistic regression analyses. A good predictive ability for CAR was shown regarding perioperative morbidity (comprehensive complication index ≥75, Clavien–Dindo score ≥4a) and 12‐month mortality, with an ideal cut‐off of CAR = 26%. Patients with CAR>26% had significantly higher median CCI scores (60 vs. 43, P < 0.001), longer intensive care unit (ICU, 5 vs. 4 days, P < 0.001) and hospital (28 vs. 21 days, P < 0.001) stays and higher 12‐month mortality rates (20% vs 6%, P < 0.001). Multivariable analyses identified CAR>26%, pre‐OLT inpatient hospitalization (including ICU) and post‐operative red blood cell transfusions as independent predictors of severe cumulative morbidity (CCI≥75). Preoperative CAR might be a reliable additional tool to predict perioperative morbidity and mortality in DDLT recipients.

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The role of recipient myosteatosis in graft and patient survival after deceased donor liver transplantation

Czigány

Kramp

Lurje

et al. 2021

J cachexia sarcopenia muscle

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Background Myosteatosis is associated with perioperative outcomes in orthotopic liver transplantation (OLT). Here, we investigated the effects of body composition and myosteatosis on long-term graft and patient survival following OLT. Methods Clinical data from 225 consecutive OLT recipients from a prospective database were retrospectively analysed (May 2010 to December 2017). Computed tomography-based lumbar skeletal muscle index (SMI) (muscle mass) and mean skeletal muscle radiation attenuation (SM-RA) (myosteatosis) were calculated using a segmentation tool (3D Slicer). Patients with low skeletal muscle mass (low SMI) and myosteatosis (low SM-RA) were identified using predefined and validated cut-off values. Results The mean donor and recipient age was 55 ± 16 and 54 ± 12 years, respectively. Some 67% of the recipients were male. The probability of graft and patient survival was significantly lower in patients with myosteatosis compared with patients with higher SM-RA values (P = 0.011 and P = 0.001, respectively). Low skeletal muscle mass alone was not associated with graft and patient survival (P = 0.273 and P = 0.278, respectively). Dividing the cohort into quartiles, based on the values of SMI and SM-RA, resulted in significant differences in patient but not in graft survival (P = 0.011). Even though multivariable analysis identified low SM-RA as an important prognostic marker (hazard ratio: 2.260, 95% confidence interval: 1.177-4.340, P = 0.014), myosteatosis lost its significance when early mortality (90 days) was excluded from the final multivariable model. Patients with myosteatosis showed significantly higher all-cause mortality and in particular higher rates of deaths due to respiratory and septic complication (P = 0.002, P = 0.022, and P = 0.049, respectively). Conclusions Preoperative myosteatosis may be an important prognostic marker in patients undergoing deceased donor liver transplantation. The prognostic value of myosteatosis seems to be particularly important in the early post-operative phase. Validation in prospective clinical trials is warranted.

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Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation

Cited by 16 publications

References 42 publications

Pretreatment peripheral neutrophils, lymphocytes and monocytes predict long-term survival in hepatocellular carcinoma

Pretreatment peripheral neutrophils, lymphocytes and monocytes predict long-term survival in hepatocellular carcinoma

Clinical value and limitations of the preoperative C‐reactive‐protein‐to‐albumin ratio in predicting post‐operative morbidity and mortality after deceased‐donor liver transplantation: a retrospective single‐centre study

The role of recipient myosteatosis in graft and patient survival after deceased donor liver transplantation

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