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Thrombopoietin Levels in Patients with Cirrhosis before and after Orthotopic Liver Transplantation

Thomas G. Martin III, MD; Kenneth A. Somberg, MD; Y. Gloria Meng, PhD; Robert L. Cohen, MD; Christian A. Heid; Frederic J. de Sauvage, PhD; and Marc A. Shuman, MD
[+] Article and Author Information

From the University of California, San Francisco, California, and Genentech. Inc., South San Francisco. California. Acknowledgment: The authors thank Robert S. Warren, MD, Assistant Professor in Residence, Department of Surgery, University of California, San Francisco, for providing the normal liver tissue samples. Grant Support: In part by grant HL54476 from the National Institutes of Health and by Genentech, Inc. Requests for Reprints: Thomas G. Martin III, MD, Division of Hematology, University of California, San Francisco, Medical Center, Box 1270, Parnassus Avenue, San Francisco, CA 94143. Current Author Addresses: Dr. Martin: Division of Hematology, University of California, San Francisco, Medical Center, Box 1270, Parnassus Avenue, San Francisco, CA 94143.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(4):285-288. doi:10.7326/0003-4819-127-4-199708150-00005
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Background: Thrombocytopenia is a common manifestation of cirrhosis.

Objectives: To determine plasma thrombopoietin levels in cirrhotic patients with thrombocytopenia, monitor those levels before and after orthotopic liver transplantation, and compare thrombopoietin messenger RNA (mRNA) levels in liver samples from cirrhotic patients and controls.

Design: A cross-sectional study of patients with cirrhosis, including a small subset of patients who had orthotopic liver transplantation.

Setting: University-affiliated hospital.

Patients: 44 patients with cirrhosis, including 17 patients who had orthotopic liver transplantation.

Intervention: Orthotopic liver transplantation.

Measurements: Plasma thrombopoietin levels in all patients, platelet counts in all patients, and thrombopoietin mRNA levels in liver samples from nine patients with cirrhosis and eight controls.

Results: Thrombopoietin levels were undetectable in 39 of 44 patients with cirrhosis. In 16 of 17 patients, the levels became detectable after liver transplantation. Thrombopoietin mRNA levels were decreased in liver samples from patients with cirrhosis compared with controls (P = 0.0103).

Conclusions: The low thrombopoietin levels in cirrhotic patients with thrombocytopenia and the increased levels after orthotopic liver transplantation suggest that impaired production of thrombopoietin may contribute to thrombocytopenia associated with cirrhosis.

Figures

Grahic Jump Location
Figure 1.
Serial thrombopoietin levels and platelet counts before and after orthotopic liver transplantation.

Representative values from one patient who had orthotopic liver transplantation are shown. Values on day 0 were measured before transplantation. Transplantation was done on day 0. The dotted horizontal line represents the detection limit of the thrombopoietin assay. OLT = orthotopic liver transplantation; TPO = thrombopoietin.

Grahic Jump Location

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