Systematic review and meta-analysis of thrombocytopenia as a predictor of post-hepatectomy liver failure

Abstract

Background: We performed a systematic review and meta-analysis to assess whether thrombocytopenia constituted a risk factor for post-hepatectomy liver failure (PHLF). Methods: We searched MEDLINE and EMBASE from inception until February the 17th, 2018 for studies reporting cases of PHLF in patients with and without thrombocytopenia (defined as a platelet count below 100 or 150 (G/l)) and/or platelet counts in patients with and without PHLF. Pooled odd ratios for PHLF, as well as mean difference in platelet counts between patients with and without PHLF, were obtained by random effects models. Robustness was tested by subgroups and leave-one out sensitivity analyses. Heterogeneity was assessed using the Q-test and quantified based on I 2 value. Results: We included 15 studies representing 3966 patients. Pooled odds ratio for PHLF in thrombocytopenic patients was 3.71 (95% CI: 2.51 to 5.48; I 2 = 0%). Pooled odds ratio was 5.53 (95% CI: 2.85 to 10.48) when pooling only studies based on preoperative platelet count, and 3.13 (95% CI: 1.75 to 5.58) when pooling studies including only patients without liver cirrhosis. The pooled mean difference in platelet counts between patients with and without PHLF was −21.2 (G/l) (95% CI: −36.1 to 6.4) in disfavor of patients with PHLF. When pooling only patients with various qualities of liver tissue, the pooled mean difference was 0.6 (G/l) (95% CI: −21.1 to 22.2). Conclusion: Preoperative and/or postoperative thrombocytopenia constitute significant risk factors for PHLF in cirrhotic and non-cirrhotic patients.

Platelet Interactions with Liver Sinusoidal Endothelial Cells and Hepatic Stellate Cells Lead to Hepatocyte Proliferation

“…These results support the observations of numerous studies summarized in our recent systematic review and meta-analysis, demonstrating that thrombocytopenia constitutes a risk factor for post-hepatectomy liver failure in humans, independently of the presence of liver cirrhosis (which might constitute a confounding factor for observing an effect of thrombocytopenia) [5].…”

“…Our results demonstrate that platelets adhere to LSECs following partial hepatectomy and suggest that this contact stimulates LSECs to release IL-6, which, in turn, stimulates secretion of HGF by HSCs. Therefore, our study suggests that the beneficial effect of platelets on the regenerative process [3,5] relies on early interactions with LSECs and then HSCs and that activated platelets constitute the trigger of liver regeneration. Future analytical studies are needed to identify the molecular actor of this phenomenon among the 124 identified proteins of the platelet proteome [27].…”

“…Platelets were shown to contribute to hepatocyte proliferation in vitro and in vivo in rodents [3]. Further, thrombocytopenia was identified as a predictor of post-hepatectomy liver failure in patients after partial hepatectomy [5], and platelet count was reported to correlate with liver volume increase after partial hepatectomy [6]. However, the mechanism by which platelets stimulate hepatocyte proliferation has unfortunately remained unknown.…”

“…In this context, platelet count was directly correlated to hepatocyte proliferation after partial hepatectomy in rodents [3]. Recently, perioperative platelet count has been identified as a predictor of post-operative liver function and mortality in cohorts of patients after partial hepatectomy [4], in cirrhotic but also in non-cirrhotic patients [5]. Moreover, the number of circulating platelets and platelet transfusion were described to correlate with liver volume increase after both partial hepatectomy [6] and living-donor liver transplantation [7], respectively.…”

Laparoscopic left hemihepatectomy in small dogs: an easy and effective new technique

“…Hepatectomy is widely used in medical research and experimental surgery, for studying liver failure (Imai et al 2019;Meyer et al 2019;Shirata et al 2019), regeneration (Schadde et al 2017;Tsai et al 2018), and transplantation (Etheredge et al 2019;Lué et al 2019;Majd et al 2019), and is one of the common hepatic procedures performed on companion animals (Boothe 2015;Zhang et al 2014). Thus, an animal model of hepatectomy is an extremely important research tool for evaluating liver regeneration after various treatments (Bernat Córdoba-Jover 2019;de Miguel et al 2019;Lee et al 2019).…”