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Early post-liver transplant thrombocytopenia in children: Clinical characteristics and significance
Noa Tal1,2, Orith Waisbourd-Zinman2,3, Eytan Kaplan2,4
1Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Insights
Post-liver transplant thrombocytopenia is common in children, affecting 89% within 28 days. Low platelet counts correlate with longer intensive care stays, indicating a need for careful monitoring after pediatric liver transplants.
Area of Science:
- Pediatric Hepatology
- Transplantation Immunology
- Hematology
Background:
- Post-liver transplant thrombocytopenia is a known complication in adults, linked to poorer outcomes.
- The prevalence, clinical course, and prognostic significance of thrombocytopenia in pediatric liver transplant recipients remain largely undescribed.
Purpose of the Study:
- To investigate the incidence, characteristics, and clinical implications of thrombocytopenia in children following liver transplantation.
Main Methods:
- Retrospective analysis of 130 pediatric liver transplant cases performed between 2004 and 2021 at a single tertiary care center.
- Evaluation of platelet counts, nadir levels, and associated clinical factors within the first 28 days post-transplant.
Main Results:
- Thrombocytopenia was observed in 89% of pediatric liver transplant recipients within 28 days post-operation (POD).
- Multivariate analysis identified preoperative platelet count, intraoperative packed red blood cell transfusion volume, and hypersplenism as predictors of lower postoperative platelet counts.
- A platelet count below the 50th percentile on POD 1 was associated with a more complex postoperative course and prolonged Pediatric Intensive Care Unit (PICU) admission.
Conclusions:
- Early post-liver transplant thrombocytopenia is highly prevalent in children.
- Preoperative thrombocytopenia, hypersplenism, and increased intraoperative transfusion requirements are associated with lower postoperative platelet counts.
- A low platelet count on POD 1 independently predicts a more complicated clinical course, necessitating vigilant monitoring in pediatric liver transplant patients.
Background:
Post-liver transplant thrombocytopenia is common and associated with worse outcome in adults. In children, however, the prevalence, course, and significance of post-liver transplantation thrombocytopenia are not described. Therefore, we aimed to assess this phenomenon in children.
Methods:
A retrospective chart review of children who underwent liver transplantation at a single tertiary center between 2004 and 2021.
Results:
Overall, 130 pediatric liver transplantations were reviewed. During the first 28 POD, thrombocytopenia was evident in 116 (89%, 95% CI 83%-94%). The median nadir platelet count was 54 K/μl (IQR: 37-99). Nadir platelet count was reached in half the patients by the third POD (IQR: 1-6). In multivariate analysis, preoperative platelet count (p = .024), volume of intraoperative packed cell transfusion (p = .045), and hypersplenism (p = .007) were associated with lower postoperative platelet counts. Patients with platelet count lower than the 50th centile on the first POD suffered from a more complicated course leading to a longer PICU admission (p = .039).
Conclusions:
Early post-liver transplant thrombocytopenia appears to be common in children and associated with preoperative thrombocytopenia, hypersplenism, and higher intraoperative blood transfusion volumes. A low first POD platelet count (<86 K/μl) was found to be independently associated with a more complicated postoperative course, suggesting the need for heightened surveillance.
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