Simultaneous splenectomy improves outcomes after adult living donor liver transplantation

Yoshizumi, Tomoharu; Itoh, Shinji; Shimokawa, Mototsugu; Inokuchi, Shoichi; Harada, Noboru; Takeishi, Kazuki; Mano, Yohei; Yoshiya, Shohei; Kurihara, Toshio; Nagao, Yuhei; Ikegami, Toru; Soejima, Yuji; Mori, Masaki

doi:10.1016/j.jhep.2020.08.017

Cited by 37 publications

(68 citation statements)

References 34 publications

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“…The role of partial splenectomy in conjunction with ligation of collaterals may give better long-term outcomes by reducing SA flow and splenic bed venous pressure in conjunction with collateral ligation. Partial splenectomy has been described in patients with haematological conditions, tumours, or trauma, or to decrease the degree of portal hypertension and small-for-size syndrome in living donor liver transplant [ 45 , 46 ]. Nam et al proposed performing splenectomy or splenic artery ligation when the spleen volume with respect to the body surface area exceeded a certain threshold [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

Cortes‐Cerisuelo

Boumpoureka

Cassar

et al. 2021

JCM

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Background: Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood. Methods: Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms. Results: Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS was present in 72.7% of the patients. Graft and patient survival at 1, 5, and 10 years was 97.1%, 91.2%, 91.2% and 100%, 94%, 94%, respectively Conclusions: Good outcomes after LT for BA in young patients can be achieved with careful donor selection and surgery to minimise the risk of complications. Identification of anatomical variants and shunting are helpful in guiding attitude at the time of transplant.

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Section: Discussionmentioning

confidence: 99%

Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

Cortes‐Cerisuelo

Boumpoureka

Cassar

et al. 2021

JCM

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“…Thus, previous studies ( 26 ) indicated that liver transplantation meanwhile splenectomy may be due to pancreatic injury, infection, and thrombosis, and the use of postoperative immunosuppressants increases this uncertainty. Yoshizumi ( 27 ) deemed that simultaneous splenectomy improves outcomes after adult LDLT. Wei ( 28 ) reported that partial splenectomy was performed in children's LDLT to cope with hypersplenism.…”

Section: Discussionmentioning

confidence: 99%

Liver Graft-to-Spleen Volume Ratio as a Useful Predictive Factor of the Outcomes in Living Donor Liver Transplantation: A Retrospective Study

Xiao

Lin

et al. 2022

Front. Surg.

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BackgroundIn living donor liver transplantation (LDLT), graft-to-recipient weight ratio (GRWR) <0. 8% is an important index for predicted portal hypertension, which may induce the graft small-for-size syndrome (SFSS). Recently, the value of graft-to-spleen volume ratio (GSVR) on predicted portal hypertension had been reported, whether without splenectomy prevent portal hypertension in transplantation remains disputed, we aimed to identify GSVR contributing to portal venous pressure (PVP) and outcomes without simultaneous splenectomy in LDLT.MethodsA retrospective study had been designed. Excluded patients with splenectomy, 246 recipients with LDLT between 2016 and 2020 were categorized into a low GSVR group and a normal GSVR group. Preoperative, intraoperative, and postoperative data were collected, then we explored different GSVR values contributing to portal hypertension after reperfusion.ResultsAccording to the first quartile of the distributed data, two groups were divided: low GSVR (<1.03 g/mL) and normal GSVR (>1.03 g/mL). For the donors, there were significant differences in donor age, graft type, liver size, GRWR, and GSVR (P < 0.05). Following the surgical factors, there were significant differences in blood loss and CRBC transfusion (P < 0.05). The low GSVR has demonstrated had a significant relationship with ascites drainage and portal venous flow after LDLT (P < 0.05). Meanwhile, low GSVR heralds worse results which covered platelet count, international normalized ratio (INR), and portal venous velocity. Kaplan–Meier analysis showed that there was a significant difference between the two groups, while the low GSVR group demonstrated worse recipients survival compared with the normal GSVR group (P < 0.05).ConclusionsWithout splenectomy, low GSVR was an important predictor of portal hypertension and impaired graft function after LDLT.

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“…In 2017, the international guidelines 65 encompassed the recommendation for portal modulation but not for splenectomy to prevent SFSS. The latter might be nuanced by a recent series 66 that reported improved outcomes after simultaneous splenectomy with living-donor LT. In practice, portal modulation might be considered in recipients with severe portal hypertension, that is, with portal pressure >15–20 mmHg and/or portal flow >300/ml/100 g graft weight.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease

et al. 2022

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Simultaneous splenectomy improves outcomes after adult living donor liver transplantation

Cited by 37 publications

References 34 publications

Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

Liver Graft-to-Spleen Volume Ratio as a Useful Predictive Factor of the Outcomes in Living Donor Liver Transplantation: A Retrospective Study

A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease

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