Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Transplant. 2022 Sep;26(6):e14326. doi: 10.1111/petr.14326. Epub 2022 May 22.
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.
A retrospective chart review of children who underwent liver transplantation at a single tertiary center between 2004 and 2021.
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).
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.
肝移植后血小板减少症在成人中很常见，且与不良预后相关。然而，在儿童中，肝移植后血小板减少症的发生率、病程和意义尚未得到描述。因此，我们旨在评估该现象在儿童中的表现。
回顾性分析了 2004 年至 2021 年期间在一家三级中心接受肝移植的儿童患者的病历。
共回顾了 130 例儿童肝移植。在术后的前 28 天内，116 例（89%，95%CI 83%-94%）出现血小板减少症。血小板计数的中位数最低点为 54 K/μl（IQR：37-99）。半数患者在第 3 天达到血小板计数最低点（IQR：1-6）。多变量分析显示，术前血小板计数（p=.024）、术中浓缩红细胞输注量（p=.045）和脾功能亢进（p=.007）与术后血小板计数较低相关。在第 1 天血小板计数低于第 50 百分位数的患者病程更为复杂，导致 ICU 住院时间延长（p=.039）。
肝移植后早期血小板减少症在儿童中似乎很常见，与术前血小板减少症、脾功能亢进和术中输血量大有关。发现第 1 天血小板计数低（<86 K/μl）与术后病程更为复杂独立相关，提示需要加强监测。
