Does auxiliary heterotopic liver transplantation reverse hypersplenism and portal hypertension?

Rinkes, Inne H.M. Borel; Hoop, A. Gerritsen van der; Hesselink, E. J.; Metselaar, Herold J.; Rave, Sjoerd de; Zonderland, Harmine M.; Schalm, Solko W.; Terpstra, Onno T.

doi:10.1016/0016-5085(91)90293-t

Cited by 24 publications

(12 citation statements)

References 13 publications

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“…The reduction in number of hematological cells in cirrhotic patients has already been shown to recover after liver transplantation in the previous studies by others (Yanaga et al 1989; Stiegler et al 1998; Borel Rinkes et al 1991; Peck-Radosavljevic et al 2000). However, those studies focused on the relatively short-term dynamics of platelets, while those over a long term and for red and white blood cells have not been well understood.…”

Section: Discussionmentioning

confidence: 74%

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Long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation-various dynamics depending on etiology

et al. 2013

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BackgroundHypersplenism is a common complication in cirrhotic patients, and liver transplantation would be one of the effective treatments. However, detailed dynamics, especially over a long term, are not fully understood. We investigated the long-term dynamics of hematological data and spleen volumes, as well as their correlation in cirrhotic patients who underwent liver transplantation.Patients and methodsWe studied 53 cirrhotic patients who underwent liver transplantation at our institute and followed for more than 1 year. Hematological data were collected from medical records, while spleen volumes were determined by CT volumetry at 0, 1, 3, 6, 12, 24, 36, 48, 60 postoperative months (POM).Results(1) Platelet (Plt) and hemoglobin (Hb) levels were gradually increased up to 18 and 10 POM, respectively, in contrast with white blood cells (WBC), which remained mostly unchanged from pretransplantation levels. (2) Spleen volume was sharply decreased in the first POM, then showed a slower but steady decline up to 48 POM. (3) Spleen volume was significantly correlated with hematological data, though the levels were generally weak (Plt: r = 0.433, p < 0.001; Hb: r = 0.233, p < 0.001; WBC: r = 0.217, p = 0.001). (4) Spleen volume was strongly correlated with all hematological parameters in HBV patients (Plt: r = 0.617, p < 0.0001; Hb: r = 0.401, p < 0.001; WBC: r = 0.387, p < 0.001), in contrast with that in other etiologies, which had generally weak correlations though some were statistically significant.ConclusionsWe investigated the long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation. Unique dynamics and correlations between them were found among the different etiologies investigated.

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Section: Discussionmentioning

confidence: 74%

“…In fact, some reports have noted that thrombopoiesis occurred soon after liver transplantation (Yanaga et al 1989; Stiegler et al 1998; Borel Rinkes et al 1991; Peck-Radosavljevic et al 2000) and spleen volumes were significantly lowered at 1-2 postoperative months as compared with the preoperative levels (Yanaga et al 1989). …”

Section: Introductionmentioning

confidence: 99%

Long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation-various dynamics depending on etiology

et al. 2013

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“…However, we and others show that the increase in platelets in peripheral blood is delayed after liver transplantation [1,7,13,30]. However, we and others show that the increase in platelets in peripheral blood is delayed after liver transplantation [1,7,13,30].…”

Section: Discussionmentioning

confidence: 90%

Direct evidence for an increase in thrombopoiesis after liver transplantation

Stiegler

Stohlawetz

Peck‐Radosavljevic

et al. 1998

Eur J Clin Investigation

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“…In a similar way to an orthotopic transplantation, a HLT usually reverses ascites and portal hypertension, which results from a significant reduction of the portocaval pressure gradient by more than 50%. However, graft congestion due to the combination of outflow syndrome and increased portal flow through the donor portal vein may occur following HLT, promoting massive ascitic fluid loss [17]. The portal blood flow diversion into the graft portal vein may lead to graft and splenic congestion with hypersplenism [18].…”

Section: Discussionmentioning

confidence: 99%

Functional, life‐threatening disorders and splenectomy following liver transplantation

Troisi¹,

Hesse²,

Decruyenaere

et al. 1999

Clinical Transplantation

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The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.

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Does auxiliary heterotopic liver transplantation reverse hypersplenism and portal hypertension?

Cited by 24 publications

References 13 publications

Long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation-various dynamics depending on etiology

Long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation-various dynamics depending on etiology

Direct evidence for an increase in thrombopoiesis after liver transplantation

Functional, life‐threatening disorders and splenectomy following liver transplantation

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