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Right Hepatic Lobe Resection and Thrombocytopenia
Abimbola Adike*, Jorge Rakela*,*, Christopher Czaplicki**, Adyr Moss***, Elizabeth Carey*
* Division of Gastroenterology and Transplant Hepatology, Mayo Clinic, Arizona, USA
** Department of Radiology, Mayo Clinic, Arizona, USA
*** Department of Transplant Surgery, Mayo Clinic, Arizona, USA
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Short Observation Report</span><p id="p0005" class="elsevierStylePara elsevierViewall">Thrombocytopenia is common following donor hepa-tectomy&#46; It has been previously reported in patients who have undergone right hepatic lobe resection for organ donation&#46; Rudow&#44; <span class="elsevierStyleItalic">et al&#46;</span> first reported this observation in 2004 in a retrospective review of 70 living donor patients after right hepatectomy and found five of 22 patients &#40;22&#37;&#41; at one year follow-up with persistent thrombocytopenia&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Since then&#44; several other studies have also reported a relationship between thrombocytopenia following right hepatic lobe resection&#46; The Adult-to-Adult Living Donor Liver Transplantation Cohort Study &#40;A2ALL&#41; of 487 living donors in 9 US transplant centers found a significant reduction in platelet count at every time point &#40;1 week&#44; 1 month&#44; 3 months&#44; 1 year and 3 years&#41; compared to pre-donation baseline and this was sustained through three years post-donation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Kim&#44; <span class="elsevierStyleItalic">et al</span>&#46; found a significant inverse relationship between platelet count and spleen volume at six months following donation&#46; Although&#44; six months is a short period to measure long-term consequences&#44; there was no difference in donor safety or postoperative complications following right donor hepatectomy with a median follow-up period of 73 months &#40;range&#44; 9-134 months&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">The etiology of thrombocytopenia following right hepatectomy remains unclear but several theories have been proposed including&#58;</p><p id="p0015" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0020" class="elsevierStylePara elsevierViewall">Decrease in thrombopoietin as a result of an incomplete hepatic regeneration following hepatectomy&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0025" class="elsevierStylePara elsevierViewall">Inadequate hepatic regeneration resulting in relative portal or hepatic insufficiency which in turn leads to elevated portal pressure&#59; and</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0030" class="elsevierStylePara elsevierViewall">Increased platelet consumption from intrahepatic and splenic congestion&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2-4</span></a></p></li></ul></p><p id="p0035" class="elsevierStylePara elsevierViewall">In our center&#44; we observed that thrombocytopenia was common following right lobe hepatectomy&#46; Comparison of thrombocytopenia in hepatectomy for neoplasia <span class="elsevierStyleItalic">vs&#46;</span> living liver donation has not been previously described&#46; We performed a retrospective review of all patients who underwent right lobe hepatectomy from 2005 - 2015&#46; Throm-bocytopenia was defined as a platelet value of less than 150 x 10<span class="elsevierStyleSup">9</span>&#47;L&#46; Spleen sizes were measured before and after surgery in the coronal and axial planes&#44; with the largest diameter used&#46; Ultrasound evaluation was used if cross sectional imaging was unavailable&#46; We excluded patients who received chemotherapy &#40;n &#61; 15&#41; which may influence platelet values in the post-hepatectomy period&#46; There were no patients with cirrhosis in either group&#46; We compared platelet values in the postoperative period of patients who underwent right hepatectomy for living donation &#40;n &#61; 93&#41; to those who underwent hepatectomy for neoplasia &#40;n &#61; 21&#41;&#46; We used unpaired and paired <span class="elsevierStyleItalic">t</span>-tests to compare both groups&#46; Mean age of patients in the neo-plasia group was 53 &#177; 16&#44; and 57&#37; were females&#46; Mean age of living donors was 37 &#177; 11&#44; and 58&#37; were females&#46; Six patients in the neoplasia group had thrombocytope-nia&#44; three at 12 months&#44; two at 3 months&#44; and 1 patient that was lost to follow up after the first month&#46; In the living donor group&#44; seven patients had thrombocytopenia at 12 months&#44; seven patients at 3 months and two patients at 1 month&#46; There was no significant difference in platelet values between the two groups at one month &#40;291&#46;2 &#177; 100 <span class="elsevierStyleItalic">vs&#46;</span> 285&#46;73 &#177; 159&#44; p &#61; NS&#41;&#44; three months &#40;223&#46;8 &#177; 61 <span class="elsevierStyleItalic">vs&#46;</span> 185&#46;27 &#177; 80&#44; p &#61; NS&#41; and at 12 months &#40;212 &#177; 44 <span class="elsevierStyleItalic">vs&#46;</span> 191 &#177; 60&#44; p &#61; NS&#41;&#46; There was a significant difference in pre- and post-hepatectomy spleen sizes in both groups of patients with available data &#40;n &#61; 36&#41;&#44; 11&#46;2 &#177; 1&#46;43 cm <span class="elsevierStyleItalic">vs&#46;</span> 12 &#177; 2&#46;12 cm&#44; p &#61; 0&#46;014 with a median follow up period of 32 days in the living donor group and 335 days in the neoplasia group&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">There are several limitations of our study&#46; Not all donors had available data at follow up intervals&#46; In addition&#44; some patients had laboratory tests that were done outside of our transplant center which contributes to the variability in normal range of lab values&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; thrombocytopenia is not uncommon following right hepatic lobe resection&#46; Thrombocytopenia after hepatectomy is unaffected by the indication for resection&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Conflict of Interest</span><p id="p0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Thrombocytopenia has previously been reported after right lobe resection for organ donation&#46; The mechanism&#40;s&#41; of low platelets after right hepatectomy is unclear and several hypotheses have been proposed including a decrease in thrombopoietin&#44; and hepatic insufficiency resulting in relative portal hypertension following hepatic resection&#46; However&#44; there has previously not been any comparison between patients who undergo hepatic resection for neoplasia <span class="elsevierStyleItalic">vs&#46;</span> for living organ donation&#46; We compared platelet values in the postoperative period of patients who underwent right hepatectomy for living donation &#40;n &#61; 93&#41; to those who underwent hepatectomy for neoplasia &#40;n &#61; 21&#41;&#46; There was no significant difference in platelet values between the two groups at one month &#40;291&#46;2 &#177; 100 <span class="elsevierStyleItalic">vs&#46;</span> 285&#46;73 &#177; 159&#44; p &#61; NS&#41;&#44; three months &#40;223&#46;8 &#177; 61 <span class="elsevierStyleItalic">vs&#46;</span> 185&#46;27 &#177; 80&#44; p &#61; NS&#41; and at 12 months &#40;212 &#177; 44 <span class="elsevierStyleItalic">vs&#46;</span> 191 &#177; 60&#44; p &#61; NS&#41;&#46; We conclude that thrombocytopenia is not uncommon following hepatic lobe resection&#44; and is unaffected by the indication for hepa-tectomy&#46;</p></span>"
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Article information
ISSN: 16652681
Original language: English
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2022 March 5 11 16
2022 February 9 5 14
2022 January 15 3 18
2021 December 5 7 12
2021 November 6 7 13
2021 October 4 8 12
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2021 April 15 9 24
2021 March 4 5 9
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2020 December 8 5 13
2020 November 2 11 13
2020 October 4 3 7
2020 September 6 6 12
2020 August 6 3 9
2020 July 5 5 10
2020 June 3 7 10
2020 May 3 5 8
2020 April 1 1 2
2020 March 2 2 4
2020 February 3 4 7
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2019 December 4 7 11
2019 November 1 2 3
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2019 August 0 1 1
2019 July 4 4 8
2019 June 9 1 10
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos