Persistent hypersplenism early after liver transplant

Background. Transient thrombocytopenia is common after liver transplantation, but persisting thrombocytopenia worsens the prognosis after transplant. Methods. Two patients underwent splenectomy for persistent thrombocytopenia early after liver transplantation. The first patient had a platelet count of 17,000/mm(3) on postoperative day (POD) 6; her hemoglobin and white blood cell counts were normal. Work-ups including bone marrow aspiration, Coombs test, and antiplatelet antibody test were negative. On POD 9, she had abdominal bleeding with a platelet count of 17,000/mm(3) despite repeated platelet transfusions, and splenectomy was done. The second patient had a platelet count of 3000/mm(3) on POD 14, white blood cell was 1600/mm(3), and hemoglobin was 7.7 g/dl. Bone marrow biopsy revealed hypercellular marrow. Because his platelet count remained at 2000/mm(3) despite empiric treatment with intravenous immune globulin and methylprednisolone, splenectomy was performed. Results. The first patient's platelet count rose to 155,000/mm(3) by POD 8. The second patient's platelet count reached 210,000/mm(3) on POD 5. Neither patient has had an episode of thrombocytopenia at 36 and 32 months after splenectomy. Conclusions. Splenectomy can be used after liver transplantation for severe, persistent thrombocytopenic states that cannot be attributed to sepsis, intravascular coagulation, immunological causes, or drug effects.