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Platelet count after living donor liver transplantation as a surrogate for portal vein pressure monitoring and predictor of graft hyperperfusion syndrome: The “5-67-8” rule

Background Thrombocytopenia early after living donor liver transplantation (LDLT) mainly occurs secondary to hepatic/splenic sequestration, a product of Portal vein pressure (PVP). Portal vein flow (PVF) unlike PVP, is mainly an inflow parameter and does not directly reflect sinusoidal pressure and predict graft dysfunction secondary to hyperperfusion syndrome (HPS). The aim of this study is to determine whether post-LDLT platelet count (PC) can reflect PVP and serve as a biomarker to predict HPS. Methods A total of 757 consecutive adult to adult LDLTs were performed from July 2010 to January 2018 at Kaohsiung Chang Gung Memorial Hospital. After excluding recipients who underwent splenectomy or splenic artery ligation, a total of 690 patients were included. Postoperative liver function, the volume of ascites and graft hemodynamics were recorded on days 1,3,5,7 and 14. Correlation analysis was done using Generalized estimating equations and Receiver operating characteristic analysis (ROC) with Youden’s index to determine the optimal cut-off point. Results A total of 201 patients (29%) developed HPS in this study. Post LDLT PC significantly correlated to PVF (p Conclusions Platelet counts within the first 2 weeks after LDLT can serve a surrogate for PVP monitoring and can be used as a guide for further inflow modulation. Furthermore, a PC on POD5 of less than or equal to 67,000 per mm3 is 80% sensitive in predicting HPS hence, the ‘5-67-8’ rule.