Early post-liver transplant thrombocytopenia in children: Clinical characteristics and significance

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.