Thrombopoietin concentrations are low in patients with cirrhosis and thrombocytopenia and are restored after orthotopic liver transplantation

Abstract

BACKGROUNDThrombocytopenia in cirrhotic patients may be due to deficient production of thrombopoietin.AIMSTo determine the relation between thrombopoietin and thrombocytopenia in cirrhotic patients before and after orthotopic liver transplantation.METHODSThrombopoietin concentrations and platelet counts were measured in 43 cirrhotic patients and 21 normal controls and serially for 14 days after transplantation in 23/43 patients.RESULTS27 of the 43 patients had thrombocytopenia (platelet count less than 120 × 109/l; group 1) whereas 16 patients had normal platelet count (group 2). Thrombopoietin concentrations were lower in group 1 than in group 2 (92.5 (20.3–286.3) v 226.6 (30.1–848.3) pg/ml, p=0.003) and normal controls (92.5 (20.3–286.3)v 158.3 (22.5–232.9) pg/ml, p=0.028). Post-transplantation thrombopoietin concentrations increased with a peak at day 5. The rise was significant in patients with low pretransplantation platelet count (89.1 (21.29–247.6) to 545.1 (66.2–2569) pg/ml; n=16, p=0.001) but not in those with normal platelet count (262.8 (30.1–848.3) to 315.1 (114–954.6) pg/ml; n=7, p=0.47). No correlation was found pretransplantation between spleen volume and platelet count (r=−0.11, p=0.6) or thrombopoietin concentrations (r=−0.04, p=0.8). However, pretransplantation thrombopoietin concentrations correlated with platelet count (r=0.47, p=0.0015), whereas an inverse correlation was found between peak thrombopoietin concentrations and nadir platelet count (r=−0.41 p=0.049) post-transplantation.CONCLUSIONSInadequate thrombopoietin production may contribute to cirrhotic thrombocytopenia. Thrombopoietin production is restored after liver transplantation leading to the resolution of thrombocytopenia.