Thrombopoietin in Postoperative Thrombocytopenia

1
11th Annual Congress of the International Liver
Transplantation Society, July 22, 2005
Thrombopoietin in Postoperative
Thrombocytopenia following Living Donor
Hepatectomy
Yoshihide Nagasako, MD1, Meang Bong Jin, MD2,
Hiroshi Miyazaki, PhD3 Masato Nakayama, MD1,
Tsuyoshi Shimamura, MD2, Hiroyuki Furukawa, MD2
Michiaki Matushita, MD1, and Satoru Todo, MD1,
The First Department of Surgery1, and The
Department of Organ Transplantation and
Regenerative Medicine2, Hokkaido University
School of Medicine Pharmaceutical Research
Laboratories, Pharmaceutical Division Kirin
Brewery Company Ltd3.
2
Background
Thrombocytopenia is common after living donor
hepatectomy but usually improves soon
after surgery. The intensity of
thrombocytopenia is correlated with the
magnitude of the hepatic resection. With
right lobe grafts now commonly used for
adult-to-adult living donor liver
transplantation, our understanding of the
factors involved in postoperative
thrombocytopenia after massive liver
resection is particularly important.
3
Aim
To explore the cause of postoperative
thrombocytopenia in left and right graft living
donors for liver transplantation.
Impaired platelet production ? or
Increased platelet consumption ?
4
Thrombopoietin (TPO)
Hematopoietic cytokine that promotes
megakaryocytic development and platelet
production. Synthesized mainly by
hepatocytes, and lesser amounts are seen in
the kidneys, and smooth muscle. Platelets
contain a receptor that efficiently binds and
removes TPO from circulation. - Serum level
is inversely related to platelet mass.
5
Materials and Methods
6
Comparison of Clinical Data between Left and
Right Donors
Left donors Right donors
P (n10)
(n10)
Value
Parameter
Age (yr)
34.7 (20-52)
34.1 (23-53)
0.90
Gender ( female)

50.0
70.0

0.65 Liver
resection ratio ()
28.2 (20.4-38.1)
62.6 (56.8-70.6)
lt 0.001 Operation time
(min)
517.2 (435-681)
569.6 (476-630)

0.14 Blood loss (ml)

318.1 (150-565)
407.0
(50-670)
0.31
Hospital stay (day)
16.6 (13-20)
18.5 (16-25)

0.10
Values represents mean (range) except gender.
7
Serial Change in Postoperative Platelet Count
8
Serial Change in Serum TPO Concentration
9
Serial Change in Postoperative D-Dimer
10
Serial Change in Spleen Volume
11
Summary
Thrombocytopenia following living donor
hepatectomy resolved within the first week
regardless of graft type. Serum TPO
concentration rose immediately after hepatectomy,
and returned nearly to preoperative level by
day 14 in both group. Postoperative elevation
of D-Dimer was significantly higher in right
donors than in left donors. In both group,
spleen volumes were enlarged significantly after
surgery.
12
Conclusion
Thrombocytopenia following living donor
hepatectomy was associated with increased
consumption of circulating platelet, possibly
due to intrahepatic and splanchnic congestion.