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Invited Critique
November 01, 2007

Impact of Graft Size on Postoperative Thrombocytopenia in Living Donor Liver Transplant—Invited Critique

Arch Surg. 2007;142(11):1058. doi:10.1001/archsurg.142.11.1058

Marubashi et al have presented their data regarding the effect of allograft size on thrombocytopenia after living donor liver transplant. The authors note that posttransplant thrombocytopenia contributes to bleeding, infection, and “a higher incidence of morbidity” and, for those with recurrent hepatitis C virus infection, it can be a contraindication to interferon therapy. The results of the study are based on the posttransplant portal venous pressure (PVP) measurements from a subset of patients. A separate smaller group underwent splenectomy, but their selection for splenectomy apparently was not based on PVP measurements. The authors found that recipients of smaller grafts tended to have higher PVPs after transplant and a persistence of relative thrombocytopenia. Among those undergoing splenectomy, platelet counts were consistently higher, regardless of the graft volume. The authors conclude that splenectomy at the time of living donor liver transplant is indicated in those recipients with relatively low graft volumes or high measured PVPs.

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