Significant correlation between spleen volume and thrombocytopenia in liver transplant patients: A concept for predicting persistent thrombocytopenia

Interferon (IFN) therapy with or without ribavirin treatment is well established as a standard antiviral treatment for hepatitis C virus (HCV)–infected patients. However, susceptibility to thrombocytopenia is a major obstacle for initiating or continuing this therapy, particularly in liver transplant (LTx) recipients with HCV. Studies have reported that splenectomy performed concurrently with LTx is a feasible strategy for conditioning patients for anti-HCV IFN therapy. However, the relationship between the severity of splenomegaly and alterations in the blood cytopenia in LTx recipients remains to be clarified. Here, we analyzed the relationship between spleen volume (SV) and thrombocytopenia in 45 patients who underwent LTx at Hiroshima University Hospital. The extent of pre-LTx splenomegaly [the SV to body surface area (BSA) ratio in an individual] was inversely correlated with both the post-LTx white blood cell count and platelet (PLT) count ( P < 0.001). Furthermore, the PLT count of patients with thrombocytopenia (PLT count ≤ 5 × 10 4 /mm 3 ) increased significantly in the group without splenomegaly (SV/BSA value < 400) versus that in the group with splenomegaly ( P = 0.005). Thus, if both splenomegaly and thrombocytopenia coexist (PLT count ≤ 5 × 10 4 /mm 3 and SV/BSA value ≥ 400), persistent thrombocytopenia is predictable after LTx.