Doppler Ultrasonography Findings of Splenic Arterial Steal Syndrome After Liver Transplant

Aggressive prevention and preemptive management of vascular complications after pediatric liver transplantation: A major impact on graft survival and long‐term outcome

“…Six patients had an abnormal arterial flow at their USD check during the first month. A splenic artery steal syndrome was diagnosed in five patients, typically during the first week (days 1‐4), and typically also in five children who had severe and long‐standing portal hypertension (cirrhotic condition with mean age at transplant = 10 years): Four patients were treated radiologically (proximal splenic artery embolization) and one was treated by a surgical reexploration with a graft repositioning and a ligation of the splenic artery . Another patient was diagnosed during the third week with an arterial stricture, and this was treated successfully by a percutaneous angioplasty (POD 17).…”

“…All of the transplants were performed over a relatively short time span (7 years) by a single team, using all of the same standardized operative strategies and techniques, as well as by employing those stated protocols for both perioperative management and immunosuppression. Interestingly, the surgical approaches that were applied for these patients were a combination of what have been recommended by different teams over the last decade, for instance, the use of microsurgical techniques, PV hypoplasia corrections, reducing the use of arterial vascular grafts, multiple USD checks during and after the LTs, and an early diagnosis and a rapid aggressive management for any vascular problem, among others . With a zero incidence of graft loss related to vascular problems and with only two of the 122 currently functioning grafts having a non‐clinically relevant vascular sequela, it can be concluded that the strategy was instrumental in achieving the excellent outcomes.…”

“…As per the protocol, all of the patients had received the same induction (anti‐interleukin‐2 monoclonal antibodies) and maintenance immunosuppression therapy (intent for tacrolimus monotherapy—associated with steroids and/or mycophenolate mofetil, when required by their clinical needs). In addition, as per the protocol, all of the patients were followed perioperatively by implementing a multifaceted strategy aimed at reducing the incidence of vascular complications; this latter strategy was used during the whole period of the study and it consisted of 4 main complementary aspects:…”

Role of Doppler Sonography in Early Detection of Splenic Steal Syndrome

“…Doppler sonography has been reported to be useful for the follow‐up of patients with splenic steal syndrome after splenic artery embolization 8 , 9 , 11 . In these studies, patients who underwent splenic artery embolization had a significant decrease in the hepatic arterial RI compared with pretreatment levels 8 , 9 , 11 .…”

“…Color Doppler sonography has been reported as a useful imaging modality to screen patients for splenic steal syndrome 8 – 11 . However, the role of Doppler sonography in this context has not been well defined because of the low specificity of this imaging modality 5 , 12 .…”