Platelet Antigen Polymorphisms in Cirrhosis: Association with Esophageal Varices Development

Heba Mohamed Abdallah,1 Iman Shaban Osheba,1 Ahmed Abdallah Salman,2 Nahla K Gaballa,3 Merhan Osama Helmi,1 Amr Ragab Ibrahim,4 Asmaa Said Shahat Atta,1 Mohammed Gaber Saad,5 Sara Mohammed Aboagiza,1 Hanaa Saied Abdel Hafez,3 Mostafa Gamal El Din El Helbawy,4 Ghada M K GabAllah,6 Ahmed Elewa,7 Mohamed Abdalla Salman,8 Nashwa Abdelmotelb Abdelmegeed1 1Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt; 2Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of Anesthesiology and Intensive Care, National Liver Institute, Menoufia University, Shebin Elkom, Egypt; 4Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt; 5Department of Anesthesiology and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 6Department of Medical Biochemistry, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt; 7General Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 8General Surgery Department, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Ahmed Abdallah Salman, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt, Tel +201000468664, Email Awea844@gmail.com; Awea84@kasralainy.edu.egBackground: Esophageal varices (EVs) are a serious consequence of portal hypertension in chronic liver disease, particularly in hepatitis C virus (HCV) infection. While endoscopy remains the gold standard for diagnosis, there is growing interest in human platelet antigen (HPA) polymorphisms as potential non-invasive markers associated with EV development.Aim: To assess the association between HPA-1, HPA-2, and HPA-3 gene polymorphisms and the presence and severity of EVs in cirrhotic patients.Methods: In this case-control study, 150 patients with HCV-related cirrhosis were enrolled and divided into two groups based on endoscopic findings: 75 with EVs and 75 without. HPA genotyping was performed using polymerase chain reaction with sequence-specific primers (PCR-SSP). Statistical analysis included univariate and multivariate logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated.Results: The HPA-3 (ab + aa) genotypes were significantly associated with the presence of EVs in univariate analysis (OR: 2.244, 95% CI: 1.039– 4.847, p = 0.040), but this association was not maintained in multivariate analysis (OR: 0.679, 95% CI: 0.209– 2.211, p = 0.521). Higher grades of varices were significantly associated with HPA-1 (a), HPA-2 (b), and HPA-3 (a) alleles (p < 0.05). Platelet count and platelet count-to-spleen diameter (PC/SD) ratio were also significantly associated with EVs in univariate analysis (p < 0.001). In multivariate analysis, serum creatinine (OR: 0.234, 95% CI: 0.116– 0.473, p < 0.001) and portal vein diameter (OR: 1.542, 95% CI: 1.231– 1.930, p < 0.001) were identified as independent predictors of EVs.Conclusion: HPA polymorphisms were associated with the presence and severity of esophageal varices but were not independent predictors. Further multicenter prospective studies are needed to clarify their clinical utility.Keywords: platelet antigen polymorphisms, cirrhosis, esophageal varices