Liver Transplanatation, Postoperative Complication, Severe Thrombocytopenia
Conditions
Keywords
Avatrombopag, Platelet recovery, Liver transplanatation, Severe Thrombocytopenia
Brief summary
Severe post-transplantation thrombocytopenia (platelet count \<30×10⁹/L) occurs frequently after liver transplantation (LT) and is associated with increased bleeding risk, allograft dysfunction, and transfusion-related complications. Avatrombopag, an oral thrombopoietin receptor agonist, is approved for thrombocytopenia in chronic liver disease but its role in the post-LT setting remains unclear. This retrospective cohort study included adult LT recipients who developed severe post-transplantation thrombocytopenia (SPT) between November 2019 and August 2025. After 1:1 propensity score matching (nearest neighbor, caliper = 0.2 SD of the logit of the propensity score) for age, sex, etiology of liver disease, cold ischemia time (CIT), intraoperative blood loss (IBL), preoperative platelet count, and Model for End-stage Liver Disease (MELD) score, 67 patients who received avatrombopag (40 mg/day for 5 days) were compared with 67 matched controls who received standard care. The primary outcome was platelet rise rate (×10⁹/L/day). Secondary outcomes included absolute platelet increase, blood product utilization, concomitant thrombopoietic agent use, and 30-day complications (thrombosis, infection, mechanical ventilation, renal replacement therapy, death).
Interventions
40 mg orally once daily for 5 days, initiated when postoperative platelet count fell below 30×10⁹/L after liver transplatation
Sponsors
Shanghai Zhongshan Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
(1) were aged 18 years or older; and (2) developed severe post transplantation thrombocytopenia (SPT), defined as a nadir platelet count below 30×10⁹/L within the first 7 days after LT.
Exclusion criteria
(1) use of avatrombopag within 4 weeks before LT; (2) second or subsequent LT; (3) death from surgical complications within 7 days after LT; (4) incomplete platelet measurement records; and (5) age younger than 18 years.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| platelet rise rate | 30 days post-LT | The platelet rise rate was calculated as (postoperative peak platelet count - postoperative nadir platelet count) divided by (time to peak - time to nadir + 1), measured in ×10⁹/L/day. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Absolute platelet increase (×10⁹ cells/L) | 30 days post-Liver transplatation | Postoperative peak minus postoperative nadir. |
| Red blood cell transfusion volume (units) | 30 days post-Liver transplatation | Units of packed red blood cells transfused within 30 days after LT. |
| Platelet transfusion volume (bags) | 30 days post-Liver transplatation | Bags of platelets transfused within 30 days after LT. |
| Concomitant thrombopoietic agent use | 30 days post-Liver transplatation | Use of other thrombopoietic agents (e.g., recombinant human thrombopoietin), recorded as binary (yes/no). |
| Infection (culture-proven + symptoms) | 30 days post-Liver transplatation | Presence of culture-confirmed infection with accompanying clinical symptoms within 30 days after LT. |
| Mechanical ventilation requirement | 30 days post-Liver transplatation | Requirement for postoperative mechanical ventilation support. |
| Renal replacement therapy requirement | 30 days post-Liver transplatation | Requirement for postoperative dialysis. |
| Thrombotic events | 30 days post-Liver transplatation | Deep vein thrombosis or hepatic artery thrombosis. |
| 30-day mortality | 30 days post-Liver transplatation | All-cause death within 30 days after liver transplantation. |
Countries
China
Outcome results
None listed