Study population

The PLATON study was a prospective observational study, conducted from February 2010 to January 2013, which was approved by our institutional review board (Comité de Protection des Personnes, Hôpital Pitié-Salpêtrière—Paris VI—Ile de France). Because care of patients conformed to standard procedures currently used in our institute and because platelet and endothelial functions were measured in residual blood samples, waived informed consent was authorized. However, oral and written information was given to the patients.

All included patients had to be aged over 18 years and to be listed on the National register of liver transplantation for liver cirrhosis. Exclusion criteria were: age below 18, re-transplantation, multiple organ transplantations, fulminant hepatitis and patients for whom platelet function could not be assessed the day of inclusion. Cirrhosis was diagnosed based on clinical, laboratory, ultrasonographic and tomodensitometric or histologic evidence. Hepatocellular carcinoma (HC) was diagnosed on the basis of tomodensitometry, magnetic resonance imagery (MRI), ultrasonography and in some case histologic evidence. The severity of cirrhosis was estimated according to Child-Turcotte-Pugh classification [11], UNOS score and MELD score.

Liver transplantation (LT) was performed using total hepatectomy with preservation of the inferior vena cava, partial clamping of the native vena cava as described elsewhere [12]. Quality of liver graft was a miscellaneous criteria, assessed before LT, in relation with accepted “donor extended criteria”[12]. We differentiated liver graft quality into two classes: good or mediocre.

All the patients received a standard immunosuppressive regimen, which included prednisone, mycophenolate, and cyclosporine or tacrolimus.