Predictive Factors For Persistent Thrombocytopenia After Adult Liver Transplantation

Background/Aims.Thrombocytopenia typically resolves with relief of portal hypertension and restoration of satisfactory hepatic function after liver transplantation (LT) but persists in some patients. The purpose of this study was to evaluate the predictive factors associated with persistent thrombocytopenia after LT, as well as to explore an effective method to resolve the persistent thrombocytopenia after LT.Methods.Between January2009and June2012,386adult patients underwent LT at our institution,258were excluded from the present study because of absence of thrombocytopenia before the transplantation, absence of follow-up for at least12months or incomplete exams data. We analyzed the impact for persistent thrombocytopenia after LT of pre-LT spleen volume, main portal vein (PV) size, coronary vein (CV) size, platelet levels and white cell levels. Then evaluated the effect of simultaneous splenic artery coractation for patients with predictive factors that determined before. Results.Our data showed thrombocytopenia reversed in67patients (52.3%)12month after liver transplantation (group R,128±42×109/L),61patients (47.7%) remained with thrombocytopenia12month after liver transplantation (group P,58±18×109/L). The persistent thrombocytopenia patients after LT displayed lower pre-LT platelet level (group P=37±23×109/L VS group R=45±16×109/L, P=0.03); larger spleen volume (group P=558±285ml VS group R=384±184ml, P<0.001); larger PV size (group P=17±3mm VS group R=15±3mm, P<0.001). There were no significant difference between pre-LT CV size, TB, Cr, INR and MELD score of two groups. Multivariate logistic regression analysis indicated per-LT spleen volume beyond500ml (P=0.012, OR=2.789,95%CI=1.249-6.227), PV size beyond15mm (P=0.017, OR=3.124,95%CI=1.230-7.933), platelet level (P=0.416, OR=0.991,95%CI=0.971-1.012). One of six(16.7%) patients who underwent splenic artery coarctation showed persistent thrombocytopenia after LT, while32patients of48(66.7%) who without coarctation showed (p=0.028).Conclusion.Platelet level raised in the first month after LT in all patients, and tend to stability after3month post-LT. Spleen volume beyond500ml and portal vein size beyond15mm at the time of LT may predict persistent thrombocytopenia at12months post-LT. Effective control of splenomegaly by splenic artery coarctation during the peri-operative period maybe the best strategy to resolve the persistent thrombocytopenia after LT.