Introduction: The aim of this study was to identify predictors of persistence of splenomegaly and thrombocytopenia after pediatric liver transplant (LT).  

Methods: Patients <18 years old who underwent LT at CHU Sainte-Justine between 2000-2013 were included. Presence of splenomegaly and platelet count (PLT) were recorded pre-LT and at 3, 6 and 12 months post-LT. Risk factors analyzed included: age at transplant, underlying liver disease, cirrhosis pre-LT, portal vein (PV) stenosis post-LT, immunosuppression, chemotherapy, and CMV/EBV viral replication by PCR.

Results: 63 patients (30 girls) were included. Median age at LT was 2.2 (0.7-7.7) years.  PLT <150x10³/mm³ were present in 29%, 25%, and 18% of patients and splenomegaly in 30%, 35%, and 32% at 3, 6 and 12 months post-LT respectively. Pre-LT PLT and splenomegaly were predictive of post-LT PLT (p<0.001) and persistent splenomegaly (p<0.0001), respectively, at all time points. Older age at transplant was predictive of lower PLT count at all time points (p<0.0001) and of splenomegaly at 6 (p=0.03) and 12 months (p=0.04). Underlying diagnosis influenced PLT at 3 (p=0.002) and 6 months (p=0.02). Cirrhosis was predictive of splenomegaly and lower PLT at all time points (p<0.02). Splenomegaly and lower PLT at 6 months were more frequent in patients with PV stenosis. Immunosuppressive regimen did not affect PLT. Chemotherapy, ganciclovir use and positive CMV or EBV PCR were not associated with more splenomegaly or lower PLT.

Conclusion: Pre-existing splenomegaly and thrombocytopenia, older age with presumably longer duration of splenomegaly, and cirrhosis were predictive of persisting splenomegaly and thrombocytopenia post-LT.