Thrombocytopenia In The Immediate Postoperative Period After Liver Transplantation: An Integrative Review

Abstract

Objective:  To investigate the impact of thrombocytopenia in the immediate postoperative period of liver transplantation (LT) on patient survival, as well as possible associated complications, synthesizing the evidence on risk factors, prevalence, and clinical outcomes. Methods:  An integrative literature review was conducted through searches in the PubMed, Web of Science, and Virtual Health Library (VHL) databases. The selection criteria included observational studies that analyzed immediate postoperative thrombocytopenia after LT. After the screening process, seven articles were selected for the final synthesis. Results:  Thrombocytopenia was a prevalent phenomenon following liver transplantation, with an average reduction of 63% and a nadir between the 3rd and 5th postoperative days. Counts below 30 x 10⁹/L and peak levels under 80 x 10³/uL were independent predictors of early mortality (18% vs. 2%), severe complications (Clavien-Dindo III/IV), and graft dysfunction. Although recovery typically occurs within 21 days, the magnitude of the platelet drop is a critical prognostic marker for both patient and graft survival. Conclusion:  Persistent thrombocytopenia after postoperative day 5 transcends mere hematological alteration, establishing itself as a robust biomarker of graft dysfunction and mortality. Thus, it should be interpreted as a systemic warning sign to guide early clinical interventions, rather than merely as a numerical target for transfusional correction. Thrombocytopenia after postoperative day 5 transcends mere hematological alteration, establishing itself as a robust biomarker of graft dysfunction and mortality. Thus, it should be interpreted as a systemic warning sign to guide early clinical interventions, rather than merely as a numerical target for transfusional correction.