Persistent splenomegaly and thrombocytopenia (PST) frequently occur after liver transplantation (LT), which could enhance the risk of complications of transplantation. We aimed to investigate the predictive factors for PST after LT.

Patients > 18 years who had undergone LT between 2016 and 2021 and had persistent splenomegaly and thrombocytopenia (PST), were considered for inclusion. A matched group without PST was selected as the control group. Patients’ data were collected from our hospital documents. Gray-scale and color Doppler ultrasonography were performed for all the included patients in order to measure various parameters of the spleen and portal vein (PV)

Seventy-eight patients were included in our study (mean age: 51.72 ± 14.5 years, F/M: 26/52). There was a significant difference in the pre-LT platelet (p < 0.001) and white blood cell (p = 0.006) counts, spleen length (p < 0.001) and creatinine level (p = 0.04) between the two groups. Anastomotic ratio (the portal vein diameter at anastomose site to preanastomose site) was significantly lower in the case group compared to the control group (p < 0.001). Spleen size and platelet count at the last measurement were significantly correlated with PV maximum velocity, pre-anastomotic site PV diameter, and anastomotic ratio. A significant correlation was also found between the platelet count and the post-anastomotic site PV diameter. Multivariate logistic regression analysis revealed pre-LT spleen length and anastomotic ratio to be independent risk factors for PST. A pre-LT spleen length of 159 mm had a sensitivity of 82% and a specificity of 87.2% while an anastomotic ratio of 0.81 had a sensitivity of 82.4% and a specificity of 61.5%, for predicting PST. Pre-LT spleen length and PV anastomotic ratio are independent risk factors for PST and the former has high sensitivity and specificity

Pre liver transplant spleen length and PV anastomotic ratio are independent risk factors for prediction PST and the anastomotic ratio has higher sensitivity and specificit