PURPOSE: The objective of the study is to determine whether an elevated platelet count (≥ 450 K/microL) correlates with acute rejection on transbronchial biopsy performed during the first month after lung transplantation.
METHODS: We retrospectively reviewed the medical records patients who underwent lung transplantation at University of Florida between January 2000 and December 2010. Acute rejection in the first month of transplantation was graded using standard histologic criteria from A0 to A4 and B0 to B4. Platelet results immediately before the transbronchial biopsy were documented. A total of 350 patients were included in the analysis.
RESULTS: Acute rejection A0, A1, A2 and A2 was present in 26%, 29%, 37% and 8% of the patients, respectively. Mean (±SD) platelet count was 334 (± 160) K/microL. Platelet counts were 269 (±120), 339 (±158), 375 (±158), 375 (±167) and 343 (±181) K/microL in groups A0, A1, A2 and A3, respectively. Platelet count was significantly different (p<0.001) among the A groups (0-3). The area under the curve with ROC analysis was 0.66 (95% CI: 0.60-0.72). A platelet count of more than 450 K/microL, has a sensitivity and specificity to predict rejection (≥ A1) of 27.7% and 95.6%, respectively. The positive and negative predictive value of this cut-off is 94.7% and 31%, respectively.
CONCLUSIONS: Platelet count above 450 K/microL in the first month post lung transplantation has a high positive predictive value for acute rejection grade ≥ A1.
CLINICAL IMPLICATIONS: A platelet count of ≥ 450 K/microL in the first month after lung transplantation suggests the presence of acute cellular rejection and should prompt further investigations for lung rejection.
DISCLOSURE: The following authors have nothing to disclose: Irina Timofte, Adriano Tonelli, Maher Baz
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