Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

Sibulesky, Lena; Nguyen, Justin H.; Paz‐Fumagalli, Ricardo; Taner, C. Burcin; Dickson, Rolland C.

doi:10.3748/wjg.15.5010

Cited by 10 publications

(9 citation statements)

References 31 publications

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“…Interferon and ribavirin therapy has been widely accepted as the treatment for recurrent disease. However, leucopenia, anemia, and thrombocytopenia which often afflict liver transplant patients, lead to failure to initiate this antiviral regimen, dose reduction, or discontinuation of therapy, which ultimately decreases the likelihood of sustained virological response (16) . Several studies have demonstrated that portosystemic shunt reduces splenic vein pressure and congestion of the spleen, and improves hypersplenism (5,17) .…”

Section: Discussionmentioning

confidence: 99%

“…Sequestration and destruction of blood elements due to hypersplenism cause anemia, thrombocytopenia and or leukopenia. Use of several medications, e.g., interferon, mycophenolate mofetil, and antivirals which are known to reduce blood elements is frequently limited in patients with (16) . Hepatitis C is the most common indication for LT, but unfortunately the virus almost always recurs.…”

Section: Discussionmentioning

confidence: 99%

“…Hypersplenism may be defined as the occurrence of leucopenia, thrombocytopenia, and or anemia due to sequestration and destruction of blood elements in enlarged, congested spleen (3,11,16) . It is frequently secondary to liver cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

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Change in platelet count in patients with hypersplenism subjected to liver transplantation

Coelho

Balbinot

Nitsche

et al. 2011

Arq. Gastroenterol.

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-Context -Most patients subjected to liver transplantation presents hypersplenism, which is reversed after the operation.However, some patients remain with moderate to intense hypersplenism. Objective -To study the effect of liver transplantation on platelet count in patients with hypersplenism. Method -Of a total of 233 patients who underwent liver transplantation, 162 were excluded from the present study because of occurrence of steroid-resistant rejection, absence of hypersplenism before the transplantation, absence of follow-up for at least 2 years or incomplete exams data. The electronic study protocols of the remaining 71 patients were reviewed to determine the demographics, etiology of cirrhosis, and results of pathologic examination of the explanted liver. Serial platelet count was obtained from the study protocol on the day before liver transplantation and 1, 2, 4, and 6 months and 1 year after liver transplantation. Statistical analysis was performed using the Student's t-test, chi-square test, and Spearman's correlation test.Results -Posttransplant platelet count at all time intervals was significantly higher than the pretransplant value (P<0.001 for all time intervals). Thrombocytopenia was reversed (platelet count >100,000/mm 3 ) in 58 patients (81.7%) 1 month after liver transplantation. Twelve patients (16.9%) remained with thrombocytopenia 1 year after liver transplantation. Three patients (4.2%) had recurrence of thrombocytopenia within 1 year after liver transplantation. There was no correlation between pretransplant platelet count and the Child-Pugh class or the MELD score. Conclusion -Liver transplantation reverses hypersplenism in most patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Change in platelet count in patients with hypersplenism subjected to liver transplantation

Coelho

Balbinot

Nitsche

et al. 2011

Arq. Gastroenterol.

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“…This procedure has been shown to be a safer alternative to splenectomy and is considered a first-line therapy for thrombocytopenia secondary to hypersplenism (2,(9)(10)(11)(12)(13)(14)(15). The goal of DSE is to eliminate the blood supply to 30%-70% of the splenic parenchyma to achieve sustained improvement in hematologic values (12).…”

mentioning

confidence: 98%

Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia: A Retrospective Analysis of 13 Patients

Bhatia¹,

Venkat²,

Echenique³

et al. 2015

Journal of Vascular and Interventional Radiology

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“…It has been successful in patients with thrombocytopenia and recurrent HCV infection who were able to undergo treatment with interferon and ribavirin as a result of ablation. [83][84][85][86] Many patients develop post-embolization syndrome, including symptoms of fever, left upper quadrant pain, pleural effusion, pneumonia, and atelectasis. Splenic abscesses and rupture are infrequent and are more commonly encountered and less tolerated by immunocompromised cirrhotic patients with a greater area of embolization.…”

Section: Partial Splenic Embolization (Pse)mentioning

confidence: 99%

Chronic hepatitis C-associated thrombocytopenia: aetiology and management

Fouad

2013

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Thrombocytopenia is perhaps the most common haematological abnormality in patients with chronic hepatitis C virus (HCV) infection. In these patients, the presence of thrombocytopenia may be a limiting factor when considering antiviral therapy and may be associated with decreased sustained virological response rates. Thrombocytopenia may interfere with diagnostic procedures such as liver biopsy, because of risk of bleeding.Pathogenetic mechanisms include hypersplenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, and aberrations of the immune system resulting in the formation of anti-platelet antibodies and/or immunecomplexes that bind to platelets and facilitate their premature clearance. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease. Therapeutic options include pharmacological and non-pharmacological therapies. This review summarizes the available data on these therapeutic options. KEYWORDS: thrombocytopenia, hepatitis C virus (HCV), cytokines Definition and prevalenceThrombocytopenia has been defined as a platelet count <150,000 cells/µL. In a recent systematic review, the definitions of thrombocytopenia varied between studies and were based either on platelet counts, with threshold levels ranging between <100,000 cells/µL and <180,000 cells/µL or on criteria set in haematological guidelines. The prevalence of thrombocytopenia related to chronic liver disease has been reported as 15% to 70% in patients with advanced fibrosis and portal hypertension, depending on the stage of the disease and the platelet level used to define thrombocytopenia. In patients with chronic HCV infection, the prevalence of thrombocytopenia ranged from 0.16% to 45.4% and more than half of the studies reported a prevalence of 24% or more. 1 Aetiology of thrombocytopenia in patients with chronic HCVThe pathophysiology of thrombocytopenia in patients with HCV-related chronic liver disease is complex and involves the interaction of multiple factors. In general, these factors may be

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Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

Cited by 10 publications

References 31 publications

Change in platelet count in patients with hypersplenism subjected to liver transplantation

Change in platelet count in patients with hypersplenism subjected to liver transplantation

Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia: A Retrospective Analysis of 13 Patients

Chronic hepatitis C-associated thrombocytopenia: aetiology and management

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