Dysfunction in patients with small-for-size grafts after living donor liver transplantation

The relationship between postoperative percentage fall of platelet (PLT) counts and graft dysfunction after living donor liver transplantation (LDLT) in recipients with small-forsize (SFS) graft has not been fully evaluated. We retrospectively studied 50 adult-to-adult LDLT recipients with a graft-to-recipient weight ratio of ,0.8% between 1999 and 2011.Graft dysfunction was defined as the presence of hyperbilirubinemia, coagulopathy, or ascites on 3 consecutive days during the first postoperative week. Each clinical sign of dysfunction was assigned 1 point. Postoperative percentage fall in PLT counts, graft dysfunction score, and postoperative complications according to the Clavien-Dindo classification were investigated. Overall, 31 patients (62%) exhibited a PLT count fall of more than 50%, and 19 (38%) patients exhibited a PLT count fall of less than 50% at postoperative day (POD) 3. Receiver operating characteristic curve analysis indicated that at POD 3, the cutoff value of PLTcount fall was 56% for a graft dysfunction score of 2 or 3 (sensitivity, 70%; specificity, 63.3%). Fourteen of 20 patients (70%) with a dysfunction score of 2 or 3 and 11 of 30 patients (37%) with a dysfunction score of 0 or 1 showed a fall in PLT count .56% at POD 3 (P ? 0.021). Grade 2 to 5 complications were more observed in patients with a dysfunction score of 2 or 3 than in patients with a dysfunction score of0 or 1 (P , 0.001). The fall of PLT count at POD 3 .56% is an ominous sign that can predict the graft dysfunction after LDLT in recipients with SFS graft.