Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1386
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
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.
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.