Thrombocytopenia is common among
liver transplant candidates and recipients. The aim of our study was to determine the incidence and outcome of new-onset immune-mediated
thrombocytopenic purpura (
ITP) following
liver transplantation at a single center. Among the 256
liver transplant recipients with an International Classification of Diseases, Ninth Edition code for
thrombocytopenia, 8 cases of new-onset
ITP were identified, leading to an overall incidence of 0.7% in 1,105 consecutive
liver transplant recipients over a 15-year period. All 8 patients were Caucasian, 5 (63%) were male, and the median age at
ITP onset was 54 years (range, 15-63). The median platelet count at presentation was 3,500 cells/mL (range, 1,000-12,000) and
liver disease was due to
hepatitis C (38%),
primary sclerosing cholangitis (38%), and
cryptogenic cirrhosis (25%). The median time from transplant to
ITP onset was 53.5 months (range, 1.9-173). Three of the 6 patients tested (50%) had cell-bound antiplatelet
antibodies, 1 patient had an underlying
hematological malignancy, and none of the organ donors had a history of
ITP.
Corticosteroids and/or
immunoglobulin infusions were effective in 4 patients. However, serial
rituximab infusions were required in 4 patients with persistent
thrombocytopenia, and 3 of them eventually required
splenectomy to induce disease remission. At a median follow-up of 19.7 months, 7 long-term survivors remain in remission with a median platelet count of 267,000 cells/mL. In conclusion, new-onset
ITP is an infrequent but important cause of severe
thrombocytopenia in
liver transplant recipients.
Corticosteroids and
immunoglobulin infusions were effective in 50% while the remainder of patients required
rituximab infusions or eventual
splenectomy for long-term disease remission.