Avatrombopag for Severe Thrombocytopenia After Liver Transplantation: A Retrospective Cohort Study

NCT07600905 — Completed, 134 participants, Shanghai Zhongshan Hospital

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Effectiveness and Safety of Avatrombopag for Severe Post-Transplantation Thrombocytopenia in Liver Transplant Recipients: A Propensity-Score Matched Retrospective Cohort Study

Registry	NCT07600905
Status	Completed
Study type	Observational
Enrollment	134 (Actual)
Sponsor	Shanghai Zhongshan Hospital (Other)
Conditions	Liver Transplanatation, Postoperative Complication, Severe Thrombocytopenia
Interventions	Avatrombopag 20 mg Oral Tablet (Drug)
Dates	start 2019-11-01, primary completion 2025-08-31, completion 2025-08-31, first posted 2026-05-22, last updated 2026-08-28
Locations	1 site in China

-Summary

Severe post-transplantation thrombocytopenia (platelet count <30×10⁹/L) occurs frequently after liver transplantation (LT) and is associated with increased bleeding risk, allograft dysfunction, and transfusion-related complications. Avatrombopag, an oral thrombopoietin receptor agonist, is approved for thrombocytopenia in chronic liver disease but its role in the post-LT setting remains unclear. This retrospective cohort study included adult LT recipients who developed severe post-transplantation thrombocytopenia (SPT) between November 2019 and August 2025. After 1:1 propensity score matching (nearest neighbor, caliper = 0.2 SD of the logit of the propensity score) for age, sex, etiology of liver disease, cold ischemia time (CIT), intraoperative blood loss (IBL), preoperative platelet count, and Model for End-stage Liver Disease (MELD) score, 67 patients who received avatrombopag (40 mg/day for 5 days) were compared with 67 matched controls who received standard care. The primary outcome was platelet rise rate (×10⁹/L/day). Secondary outcomes included absolute platelet increase, blood product utilization, concomitant thrombopoietic agent use, and 30-day complications (thrombosis, infection, mechanical ventilation, renal replacement therapy, death).

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+Arms and interventions

Arm	Type	Interventions	Description
Arm 1: Avatrombopag Group / Arm 2: Control Group		Drug: Avatrombopag 20 mg Oral Tablet	Arm 1: Avatrombopag Group. Standard postoperative care with 40 mg orally once daily for 5 days, initiated when postoperative platelet count fell below 30×10⁹/L. Arm 2: Control Group. Standard postoperative care without avatrombopag

Avatrombopag 20 mg Oral Tablet (Drug): 40 mg orally once daily for 5 days, initiated when postoperative platelet count fell below 30×10⁹/L after liver transplatation

+Outcome measures

Primary outcomes

platelet rise rate [30 days post-LT]: The platelet rise rate was calculated as (postoperative peak platelet count - postoperative nadir platelet count) divided by (time to peak - time to nadir + 1), measured in ×10⁹/L/day.

Secondary outcomes

Absolute platelet increase (×10⁹ cells/L) [30 days post-Liver transplatation]: Postoperative peak minus postoperative nadir.
Red blood cell transfusion volume (units) [30 days post-Liver transplatation]: Units of packed red blood cells transfused within 30 days after LT.
Platelet transfusion volume (bags) [30 days post-Liver transplatation]: Bags of platelets transfused within 30 days after LT.
Concomitant thrombopoietic agent use [30 days post-Liver transplatation]: Use of other thrombopoietic agents (e.g., recombinant human thrombopoietin), recorded as binary (yes/no).
Infection (culture-proven + symptoms) [30 days post-Liver transplatation]: Presence of culture-confirmed infection with accompanying clinical symptoms within 30 days after LT.
Mechanical ventilation requirement [30 days post-Liver transplatation]: Requirement for postoperative mechanical ventilation support.
Renal replacement therapy requirement [30 days post-Liver transplatation]: Requirement for postoperative dialysis.
Thrombotic events [30 days post-Liver transplatation]: Deep vein thrombosis or hepatic artery thrombosis.
30-day mortality [30 days post-Liver transplatation]: All-cause death within 30 days after liver transplantation.

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria: (1) were aged 18 years or older; and (2) developed severe post transplantation thrombocytopenia (SPT), defined as a nadir platelet count below 30×10⁹/L within the first 7 days after LT.

Exclusion criteria: (1) use of avatrombopag within 4 weeks before LT; (2) second or subsequent LT; (3) death from surgical complications within 7 days after LT; (4) incomplete platelet measurement records; and (5) age younger than 18 years.

+Locations (1)

Facility	City	Country	Status
Zhongshan Hospital, Fudan University	Shanghai, Shanghai Municipality	China