Thrombocytopenia and splenomegaly are two complications of portal hypertension in the patients with end stage liver disease. We expected resolution of them after liver transplantation (LT) but they persist in some patients. The purpose of this study was to evaluate the portal vein doppler findings in patients with and without these complications after LT to identifying factors associated with their pathogenesis and etiologies.

Adults with thrombocytopenia and splenomegaly at the time of LT were assessed and divided into the two groups: with and without persistent splenomegaly and thrombocytopenia defined as persistently low platelet count and high spleen size at least 12 months after LT. Color doppler ultrasound was performed for all patients. The laboratory, ultrasound and clinical data of patients were compared between the two groups.

Thirty-nine patients as case and 39 as control group were selected. Etiology of transplant, age, sex, duration of transplant, MELD score did not differ significantly between the two groups. The anastomose ratio (the portal vein diameter at anastomose site to preanastomose site) was lower and the portal-blood flow velocity at the anastomosis site was higher in the case group. The platelet counts after LT correlated with splenic diameter, anastomose ratio, pretransplant spleen size and pretransplant platelet counts (r=-0.75, 0.41, -0.64 and 0.56; respectively). Multivariable logistic regression analysis showed pretransplant spleen size and anastomose ratio in the portal vein after LT associated with persistent thrombocytopenia and splenomegaly.

In cases without improvement of splenomegaly and thrombocytopenia after transplant, should be considered a possible indicator of stenosis in the portal vein at anastomose site. Splenomegaly before transplant is closely associated with delayed recovery of spleen size and platelet count after LT.