Acute thrombocytopenia after liver transplant: role of platelet activation, thrombopoietin deficiency and response to high dose intravenous IgG treatment.
OBJECTIVE
Thrombocytopenia is common after liver transplantation due to platelet sequestration secondary to hypersplenism. The aim of this study was to further investigate the causes of this condition, as well as the response of thrombocytopenia to high dose intravenous immunoglobulins.


METHODS
We retrospectively studied 73 patients who underwent liver transplantation. Out of these 73 patients, 27 had severe thrombocytopenia and were treated with high dose intravenous immunoglobulin. Additionally, we retrospectively studied 8 patients undergoing liver transplantation.


RESULTS
Our data suggest that splenomegaly is not the only factor responsible for thrombocytopenia after liver transplantion and two additional phenomena, namely, reduced platelet production due to reduced thrombopoietin levels and sustained platelets activation take part in the pathogenesis of this condition. The infusion of high dose immunoglobulins induced a safe, prompt, complete and persistent resolution of severe thrombocytopenia in more than 70% of patients.


CONCLUSIONS
Based on these findings, treatment with high dose intravenous immunoglobulins should be considered in the management of severe thrombocytopenia after liver transplant, although additional randomized trials are warranted.
Nascimbene
Angelo
A
Department of Internal Medicine, University of Texas at Houston, 6431 Fannin Street, Suite 1.134, Houston, TX 77030, USA. Angelo.Nascimbene@uth.tmc.edu
Iannacone
Matteo
M
Brando
Bruno
B
De Gasperi
Andrea
A
D000208:Acute Disease; D001792:Blood Platelets / Q000187:drug effects / Q000276:immunology; D049109:Cell Proliferation / Q000187:drug effects; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000009:adverse effects*; D015539:Platelet Activation / Q000187:drug effects / Q000502:physiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D013163:Splenomegaly / Q000150:complications / Q000503:physiopathology; D013921:Thrombocytopenia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D013926:Thrombopoietin / Q000172:deficiency*; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D013926:Thrombopoietin