PERSISTENT HYPERSPLENISM EARLY AFTER LIVER-TRANSPLANT

Background. Transient thrombocytopenia is common after liver transplan tation, but persisting thrombocytopenia worsens the prognosis after tr ansplant. Methods. Two patients underwent splenectomy for persistent t hrombocytopenia early after liver transplantation. The first patient h ad 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 w ere negative. On POD 9, she had abdominal bleeding with a platelet cou nt of 17,000/mm(3) despite repeated platelet transfusions, and splenec tomy was done. The second patient had a platelet count of 3000/mm(3) o n POD 14, white blood cell was 1600/mm(3), and hemoglobin was 7.7 g/dl . Bone marrow biopsy revealed hypercellular marrow. Because his platel et count remained at 2000/mm(3) despite empiric treatment with intrave nous 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 P OD 5. Neither patient has had an episode of thrombocytopenia at 36 and 32 months after splenectomy. Conclusions. Splenectomy can be used aft er liver transplantation for severe, persistent thrombocytopenic state s that cannot be attributed to sepsis, intravascular coagulation, immu nological causes, or drug effects.