Postoperative Decrease in Platelet Counts Is Associated with Delayed Liver Function Recovery and Complications after Partial Hepatectomy

Abstract

Peripheral platelet counts decrease after partial hepatectomy; however, the implications of this phenomenon are unclear. We assessed if the observed decrease in platelet counts was associated with postoperative liver function and morbidity (complications grade ≤ II according to the Clavien-Dindo classification). We enrolled 216 consecutive patients who underwent partial hepatectomy for primary liver cancers, metastatic liver cancers, benign tumors, and donor hepatectomy. We classified patients as either low or high platelet percentage (postoperative platelet count/preoperative platelet count) using the optimal cutoff value calculated by a receiver operating characteristic (ROC) curve analysis, and analyzed risk factors for delayed liver functional recovery and morbidity after hepatectomy. Delayed liver function recovery and morbidity were significantly correlated with the lowest value of platelet percentage based on ROC analysis. Using a cutoff value of 60% acquired by ROC analysis, univariate and multivariate analysis determined that postoperative lowest platelet percentage ≤ 60% was identified as an independent risk factor of delayed liver function recovery (odds ratio (OR) 6.85; P < 0.01) and morbidity (OR, 4.90; P < 0.01). Furthermore, patients with the lowest platelet percentage ≤ 60% had decreased postoperative prothrombin time ratio and serum albumin level and increased serum bilirubin level when compared with patients with platelet percentage ≥ 61%. A greater than 40% decrease in platelet count after partial hepatectomy was an independent risk factor for delayed liver function recovery and postoperative morbidity. In conclusion, the decrease in platelet counts is an early marker to predict the liver function recovery and complications after hepatectomy.

Meta-analysis of the prognostic role of perioperative platelet count in posthepatectomy liver failure and mortality

“…A further 611 articles were excluded for various reasons, such as irrelevant studies, experimental studies or review articles. After reading the remaining 103 articles, 16 studies were included in the qualitative analysis.…”

“…Predicting risk factors for PHLF plays a vital role in planning a patient's perioperative course and decreasing liver‐related mortality after hepatectomy. A review of the literature showed that PHLF rates range from 0 to 43·1 per cent, and mortality rates between 0·5 and 15·6 per cent. This variation can be explained by use of different definitions of PHLF, different time points for mortality, and variability in the degree of hepatectomy, which led to clinical heterogeneity between included studies.…”

Impaired liver regeneration after hepatectomy and bleeding is associated with a shift from hepatocyte proliferation to hypertrophy

“…In recent years, experimental studies have demonstrated that platelets play an important role in promoting liver regeneration after hepatectomy. One clinical study demonstrated that a decrease of the postoperative platelet percentage to below 60% after hepatectomy was associated with delayed liver function recovery and postoperative morbidity (45). Although platelet counts reached a minimum on POD 3 for all patients (45), when platelet counts returned to preoperative levels significantly earlier, it was indicative of better functional recovery.…”

“…One clinical study demonstrated that a decrease of the postoperative platelet percentage to below 60% after hepatectomy was associated with delayed liver function recovery and postoperative morbidity (45). Although platelet counts reached a minimum on POD 3 for all patients (45), when platelet counts returned to preoperative levels significantly earlier, it was indicative of better functional recovery. In the current study, a significantly prolonged reduction in platelet count was observed for the PHx and bleeding group compared to PHx alone, which probably contributed to the observed delayed regeneration.…”

Thrombocytopenia after liver transplantation: Should we care?

“…Lower platelet counts lead to poor graft regeneration but lower incidences of ischemia-reperfusion injury in partial grafts. Overall higher platelets counts are beneficial because their impact on liver regeneration outweighs the associated risk of ischemia-reperfusion injury, most notably during the early post-LDLT period[ 52 ]. Animal experiments to explain this phenomenon are still lacking, and basic studies and prospective clinical trials are warranted.…”