Thrombocytopenia is prevalent in living donor liver transplantation (LDLT), resulting from underlying liver disease and perioperative factors. Although platelet transfusions are frequently required, their response is variable and may be associated with adverse outcomes. This study evaluated the prevalence and severity of thrombocytopenia, platelet transfusion practices, assessed post-transfusion response using corrected count increment (CCI), and predictors of poor CCI in adult LDLT recipients.

This prospective observational study was conducted at a quaternary care center after ethical committee approval. Adult LDLT recipients were enrolled, and clinical, biochemical, intraoperative, and transfusion data were collected. Platelet transfusion response was assessed using CCI post-transfusion; CCI < 5,000 was considered a poor response.

Among 100 LDLT recipients (median age 52 years; 88% male), preoperative thrombocytopenia was observed in 91% of patients (17% severe). Intraoperative platelet transfusions were administered in 18% of cases. Postoperatively, 66 platelet transfusions were given to 23 patients, with a mean CCI of 9.0 × 10 ⁹ /L. Poor CCI was observed in 10 patients and was associated with higher bilirubin levels, prolonged INR, longer ICU stay, and increased 30-day mortality. Early allograft dysfunction (EAD) at postoperative day 7 was an independent predictor of poor CCI (OR 10.2, 95% CI 2.4–43.1). An absolute platelet count ≤ 71,000/mm ³ on day 7 predicted EAD with 85% sensitivity (AUC 0.79).

Thrombocytopenia is highly prevalent in LDLT recipients. Poor CCI is associated with graft dysfunction and adverse outcomes, suggesting that CCI monitoring may help to prognosticate and anticipate worser outcomes.