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World J Gastroenterol. Apr 7, 2018; 24(13): 1386-1397
Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1386
Thrombocytopenia after liver transplantation: Should we care?
Kazuhiro Takahashi, Shunji Nagai, Mohamed Safwan, Chen Liang, Nobuhiro Ohkohchi
Kazuhiro Takahashi, Chen Liang, Nobuhiro Ohkohchi, Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, Tsukuba, Ibaraki 3058575, Japan
Shunji Nagai, Mohamed Safwan, Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, ML 48202, United States
Author contributions: Takahashi K, Nagai S, Safwan M, Liang C and Ohkohchi N contributed equally to this work; Takahashi K wrote the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nobuhiro Ohkohchi, MD, PhD, Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan. nokochi3@md.tsukuba.ac.jp
Telephone: +81-29-8533221 Fax: +81-29-8533222
Received: January 30, 2018
Peer-review started: January 31, 2018
First decision: February 11, 2018
Revised: March 6, 2018
Accepted: March 18, 2018
Article in press: March 18, 2018
Published online: April 7, 2018
Processing time: 63 Days and 23.4 Hours
Abstract

Transient thrombocytopenia is a common phenomenon after liver transplantation. After liver transplantation (LT), platelet count decreases and reaches a nadir on postoperative days 3-5, with an average reduction in platelet counts of 60%; platelet count recovers to preoperative levels approximately two weeks after LT. The putative mechanisms include haemodilution, decreased platelet production, increased sequestration, medications, infections, thrombosis, or combination of these processes. However, the precise mechanisms remain unclear. The role of platelets in liver transplantation has been highlighted in recent years, and particular attention has been given to their effects beyond hemostasis and thrombosis. Previous studies have demonstrated that perioperative thrombocytopenia causes poor graft regeneration, increases the incidence of postoperative morbidity, and deteriorates the graft and decreases patient survival in both the short and long term after liver transplantation. Platelet therapies to increase perioperative platelet counts, such as thrombopoietin, thrombopoietin receptor agonist, platelet transfusion, splenectomy, and intravenous immunoglobulin treatment might have a potential for improving graft survival, however clinical trials are lacking. Further studies are warranted to detect direct evidence on whether thrombocytopenia is the cause or result of poor-graft function and postoperative complications, and to determine who needs platelet therapies in order to prevent postoperative complications and thus improve post-transplant outcomes.

Keywords: Thrombocytopenia; Liver regeneration; Platelet therapy; Platelet; Thrombopoietin receptor agonist; Intravenous immunoglobulin treatment; Liver transplantation

Core tip: Transient thrombocytopenia is commonly seen after liver transplantation, and many studies have demonstrated that perioperative thrombocytopenia is associated with deterioration of the graft and decreased patient survival after liver transplantation. The role of platelets in liver transplantation has recently been highlighted, and particular attention has been given to their effects beyond hemostasis and thrombosis. Platelet therapies that increase platelet count, such as thrombopoietin, thrombopoietin receptor agonist, platelet transfusion, splenectomy, and intravenous immunoglobulin treatment, have a potential role for improving graft survival; however, clinical trials are still lacking, and further studies are warranted.