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Platelet count predictive of mortality in patients awaiting liver transplant

Patients with low platelet counts on a waiting list for liver transplantation had higher death rates and shorter survival times than those with higher platelet counts in a recent study.

Researchers performed tests and volumetric liver measurements on 181 patients scheduled for liver transplantation between January 2001 and April 2006, with follow-up through January 2011. Mean age of participants was 51.8 years, mean MELD score was 14 and mean platelet count was 103,600/mcL. Patients’ mean liver volume ratio (LVR; actual liver volume over expected liver volume) was 0.95.

During the study, 63 patients died, 64 underwent transplantation and 54 survived without transplant. Participants who died awaiting transplantation had a lower LVR (0.88 vs. 0.98; P=.044) and platelet count (80,000/mcL vs. 116,000/mcL; P<.0001) than survivors, while no significant differences were observed between groups for disease etiology, serum albumin levels, body surface area, MELD score and individual MELD components.

Multivariate analysis of platelet count (HR=0.987; 95% CI, 0.979-0.994) and MELD score (HR=1.046; 95% CI, 1.006-1.087) were predictive of mortality. These associations remained after adjustment for disease etiology (HR=0.987; 95% CI, 0.980-0.995 for platelet count; HR=1.076; 95% CI, 1.029-1.124 for MELD).

A linear correlation was observed between platelet count and survival time (P=.01). Compared with patients with platelet counts greater than 100,000/mcL, those with lower counts died more frequently (42.2% of cases vs. 23.6%; P=.01), had shorter survival (935 days vs. 1,396 days; P=.002) and survived without transplantation less often (21% vs. 43%; P=.0026). Transplantation rates were similar between groups (36.7% of cases vs. 33.3%; P=.64).

“Any increase in the accuracy of the listing system would result in [a] decrease in waiting list mortality and greater success in the process of transplantation,” the researchers wrote. “Adding platelet count as a continuous variable or using a particular cut-off may add to the accuracy of MELD and positively affect the waiting process. As our study is of a relatively small sample size, further large-scale studies are warranted to delineate the value of platelet count in predicting mortality in cirrhosis patients.”