Abstract:

Objective To evaluate the clinical efficacy of avatrombopag in the treatment of severethrombocytopenia during the perioperative period of liver transplantation， and to compare it with recombinant human thrombopoietin （rhTPO） and platelet transfusion. Methods A retrospective analysis was conducted on 88 patientswho developed severe thrombocytopenia after liver transplantation between May 2019 and December 2023 in TongjiHospital， Tongji Medical College， Huazhong University of Science and Technology. Patients were divided into threegroups based on treatment: avatrombopag group （n ＝ 33）， rhTPO group （n ＝ 27）， and platelet transfusion group（n＝28）. The primary endpoint was the effective rate, which was defined as platelet count ＞50×109 /L or an increase＞ 20×109 /L on day 7 post-treatment. Results The avatrombopag group achieved a significantly higher effective rate of 96.97% on day 7 compared to the rhTPO group （70.37%，P ＝ 0.008） and platelet transfusion group （60.71%，P ＜ 0.001）. Platelet counts in the avatrombopag group showed significant improvement from day 3 and reached effective levels by day 5 in most patients. Baseline characteristics were comparable across groups. Conclusion Avatrombopag demonstrates superior efficacy over rhTPO and platelet transfusion in managing severe perioperativethrombocytopenia following liver transplantation， with rapid onset and favorable safety profile. Further multicenter randomized controlled trials are warranted. 

Key words:

Liver transplantation ,  , Thrombocytopenia ,  , Avatrombopag ,  , Recombinant human thrombopoietin,  , Perioperative managemen

摘要：

目的 评估阿伐曲泊帕在肝移植围手术期重度血小板减少症中的临床疗效，并与重组人血小板生成素（recombinant humanthrombopoietin，rhTPO）及输注血小板进行比较。方法 回顾性分析 2019 年 5 月至 2023 年 12 月期间华中科技大学同济医学院附属同济医院 88 例肝移植术后出现重度血小板减少症患者的临床资料，根据治疗方法分为阿伐曲泊帕组（n ＝ 33）、rhTPO 组（n ＝ 27）和输注血小板组（n ＝ 28）。主要评价指标为治疗后第 7 天血小板计数＞ 50×109 /L 或升高＞ 20×109 /L 的有效率。结果 阿伐曲泊帕组的 7 d有效率为 96.97%，显著高于 rhTPO 组的 70.37%（P ＝ 0.008）和输注血小板组的 60.71%（P ＜ 0.001）。治疗后第 3 天血小板计数即显著升高，第 5 天大多可达治疗有效水平。3 组基线特征无统计学差异。结论 阿伐曲泊帕在治疗肝移植围手术期重度血小板减少症中疗效显著，优于 rhTPO 和输注血小板，且起效快，安全性良好，具有重要临床价值。需进一步多中心随机对照研究验证。

关键词:

肝移植 , 血小板减少症 , 阿伐曲泊帕 , 重组人血小板生成素 , 围手术期治疗