The risk factors of persistent thrombocytopenia and splenomegaly after liver transplantation

Purpose: The occurrence of thrombocytopenia in the perioperative period after liver transplantation (LT) in patients with portal hypertension is not uncommon. In most cases, thrombocytopenia in the early period after LT recovers with the restoration of the graft hepatic function. In contrast, the recovery of pre-transplant thrombocytopenia differs among patients, and some patients experience persistent thrombocytopenia and splenomegaly even several years after LT. Methods: We retrospectively reviewed the clinical records of 38 liver transplant patients who had at least a 1-year follow-up in our institute. The serial platelet counts and the spleen volumes estimated by the CT scans were obtained before LT and at 1 month, 1 year, and 3 years after LT. In cases with persistent thrombocytopenia (less than 100,000/μl beyond 1 year after LT) and splenomegaly after LT, the associated clinical factors were reviewed. Results: The platelet counts increased and the spleen volumes decreased continuously in most cases after LT. However, six patients (15.8%) were categorized as persistent thrombocytopenia. The spleen volumes of these six patients decreased more slowly after LT, and, in some cases, showed even re-increased volumes. The factors such as the age at LT, GRWR, the existence of hepatopulmonary syndrome, and the existence of biliary complication after LT were associated with persistent thrombocytopenia after LT. Conclusions: The evaluation of the pre-transplant spleen volumes and the platelet counts before LT thus makes it possible to predict the persistent thrombocytopenia after LT.