title: Factors associated with persistent thrombocytopenia after liver transplantation.
abstract: BACKGROUND
  Thrombocytopenia typically resolves with resolution of portal hypertension after liver transplantation (LT) but persists in some patients. Identifying risk factors associated with persistent post- LT thrombocytopenia may provide important information about its pathogenesis.
  
  
  METHODS
  Cirrhotic adults with platelet levels of <150,000 mu/L at the time of LT and followed at least 1 year were studied. A retrospective analysis of lab values, radiologic spleen index (SI), and donor data using nonparametric methods was performed to characterize patients having persistent thrombocytopenia, defined as persistently low platelet levels at 3 and 12 months after LT.
  
  
  RESULTS
  One hundred patients were studied: mean age 55 y (range 23-75 y); platelet count at LT 62,000/microL (range 14,000- 148,000/microL; mean total bilirubin 2.6 mg/dL; mean Mayo end-stage liver disease score 29; SI 1,476 (range 347-4,843 mL; normal 120-480 mL). Platelet count at 3 and 12 months after LT correlated with SI (r = -0.41 and -0.54; P < .001). Fifty-seven patients had persistent thrombocytopenia. Compared with patients whose platelet levels normalized by month 3 or 12, they had higher SI and lower platelet count before LT (P < .001). The SI and platelet levels at the time of LT were independent predictive factors for platelet levels at 3 and 12 months after LT (P < .001).
  
  
  CONCLUSIONS
  High SI and low platelet count at the time of LT are associated with persistent thrombocytopenia after LT. They are also independent predictive factors of platelet levels at 3 and 12 months after LT. This suggests that patients may have persistent thrombocytopenia after LT owing to persistence of some degree of hypersplenism and incomplete resolution of splenomegaly.
authors.affiliation: Division of Liver Diseases, Mount Sinai Medical Center, New York, New York 10029, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Stanca
authors.forename: M I
authors.initials: MI
authors.lastname: Fiel
authors.forename: L
authors.initials: L
authors.lastname: Aledort
authors.forename: E
authors.initials: E
authors.lastname: Cohen
authors.forename: J
authors.initials: J
authors.lastname: del Rio Martin
authors.forename: T D
authors.initials: TD
authors.lastname: Schiano
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000453:epidemiology*
chemical_list: D001663:Bilirubin