Thrombocytopenia, splenomegaly, and portal blood flow in patients who have undergone liver transplantation for cirrhosis

Abstract

The platelet count (PC), the spleen size (SS), and the portal blood flow (PBF) have been independently studied in the perioperative period after orthotopic liver transplantation (OLT) for cirrhosis, but these parameters have not been described and analyzed in combination. We analyzed PC data and Doppler sonography measurements of SS and PBF from 125 adult patients before OLT and 1, 3, 6, 9, and 12 months after transplantation. A linear mixed model with fixed subject random intercepts was used. PCs increased significantly from 101.5 ± 68.5 × 10(9) /L before OLT to 162.4 ± 86 × 10(9) /L 1 month after OLT and remained stable for 1 year after the operation. PBF increased significantly from 619 ± 239 mL/minute before OLT to 1379 ± 491 mL/minute after OLT and remained stable during the first year. SS slowly decreased after OLT, but the decrease became significant only 9 months after the operation (13.8 ± 4.2 cm before OLT versus 11.7 ± 3.7 cm at 9 months, P < 0.05). The cirrhosis etiology did not influence the evolution of the parameters. With or without replication or interferon treatment before OLT, the hepatitis C group viruses did not influence PCs postoperatively. The evolution of SS was correlated to the evolution of PCs in the year after transplantation. In conclusion, PCs and PBF increase rapidly after OLT, whereas SS slowly decreases. The cirrhosis etiology does not influence the evolution of PCs. Thrombocytopenia and splenomegaly are 2 results of portal hypertension, but the rapid normalization of PBF does not completely or rapidly reverse these 2 phenomena.

Use of Analytic Morphomics of Liver, Spleen, and Body Composition to Identify Patients at Risk for Cirrhosis

“…Laboratory findings are also less valuable because many patients after liver transplantation continue to have thrombocytopenia despite a normally functioning liver. 17,18 In addition to the importance of knowing transplant status, we found that the relative distance of portal vein to caudate lobe was also another important predictor for cirrhosis because it was found in all the models. This is consistent with previous finding showing that enlargement of the caudate lobe is a marker of cirrhosis.…”

Low platelet counts after liver transplantation predict early posttransplant survival: The 60-5 criterion

“…Clinical research about postoperative laboratory variables is, therefore, scarce . Thrombocytopenia is common in the early postoperative period after LT because of consumption in hemostatic processes and platelet sequestration in the reperfused liver graft . In old reports, persistent thrombocytopenia after LT was found to be associated with poor outcomes, including severe postoperative infections, increased allograft dysfunction, and decreased patient survival .…”

Spleen Size in Cirrhosis of Different Etiologies

“…), who was blinded to the patients' characteristics. Spleen size on sonography was defined as the maximum diagonal spleen length when measured on a single sagittal or parasagittal sonogram 9 . Spleen size on CT was determined as the maximum spleen diameter found on an axial, coronal, or sagittal view, whichever was largest.…”

“…Spleen size on sonography was defined as the maximum diagonal spleen length when measured on a single sagittal or parasagittal sonogram. 9 Spleen size on CT was determined as the maximum spleen diameter found on an axial, coronal, or sagittal view, whichever was largest. We believe that this method of measuring spleen diameter on CT is well correlated with spleen length as measured by sonography.…”

“…8 The exclusion criteria for the study were a history of hepatocellular carcinoma, congestive heart failure, portal vein thrombosis, and any other known cause of splenomegaly (ie, infections, blood dyscrasia, or lymphoproliferative disorders); also excluded were patients who had received orthotopic liver transplantation or a transjugular intrahepatic portosystemic shunt, since studies have shown that orthotopic liver transplantation and transjugular intrahepatic portosystemic shunts can affect spleen size. 9,10 In addition, patients with more than 1 major etiologic factor of cirrhosis (alcohol, hepatitis C, and nonalcoholic steatohepatitis) or other etiologic factors such as autoimmune hepatitis and primary biliary cirrhosis were omitted. Of 385 patient records, 246 were excluded ( Table 2); 139 patients were enrolled in the analysis, all of whom had a diagnosis of cirrhosis secondary to alcohol, hepatitis C, or nonalcoholic steatohepatitis.…”