Living with a transplanted liver is associated with cytopenias: A nationwide cohort study

Kajinth Manogarathaas¹Nicoline Stender Arentoft¹Jens Hillingsø²Anne Marie Reimer Jensen¹Annette Dam Fialla³Gerda Elisabeth Villadsen⁴Peter Holland-Fischer⁵Shoaib Afzal^6,7Børge Grønne Nordestgaard^6,7Peter Brown⁸Allan Rasmussen²Susanne Dam Nielsen^1,2,7*

• ¹Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
• ²Department of Surgery and Transplantation, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
• ³Department of Gastroenterology, Odense University Hospital, Odense, Denmark
• ⁴Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
• ⁵Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
• ⁶Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
• ⁷Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark
• ⁸Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Zealand, Denmark

Hematological abnormalities are common in liver transplant recipients, but evidence beyond the first-year post-transplantation is scarce. We aimed to evaluate hematological abnormalities in liver transplant recipients beyond the first-year post-transplantation. We included 437 liver transplant recipients and 1,744 age-and sex-matched controls from the general population. Odds for cytopenias were assessed using logistic regression analyses adjusted for age, sex, ethnicity, hs-CRP, smoking, and alcohol use. Potential transplant-related risk factors were assessed in liver transplant recipients only. The median time since transplantation was 7.8 years, and 47% had autoimmune liver disease as the indication for transplantation. Compared to controls, liver transplant recipients had a higher prevalence of anemia (24.5% vs. 3.5%), neutropenia (2.1% vs. 0.1%), lymphocytopenia (18.4% vs. 1.5%), and thrombocytopenia (19.2% vs. 2.2%). Living with a transplanted liver was independently associated with higher odds of anemia (aOR, 7.84 [95% CI: 5.04 -12.18], p<0.001), lymphocytopenia (aOR 16.69 [95% CI: 9.56 -29.12], p<0.001), and thrombocytopenia (aOR 10.19 [95% CI: 6.07 -17.13], p<0.001). No association was found between cytopenias, specific types of immunosuppressive treatments, or cirrhosis at transplantation.In conclusion, hematological abnormalities are common in liver transplant recipients, even several years post-transplantation, and increased attention towards cytopenia in this population is warranted.