Evaluation the efficacy and safety of simultaneous splenectomy in liver transplantation patients

Abstract

Background:Simultaneous splenectomy during liver transplantation (LT) is debated. The present meta-analysis assessed the efficacy and safety of splenectomy on the outcome of LT patients.Methods:We searched PubMed, Embase, and Wanfang databases for relevant studies published until the date of July 15, 2017. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. The data were analyzed using RevMan5.3 software.Results:A total of 16 studies consisting of 2198 patients (892 patients received splenectomy during LT [SPLT group] and 1306 patients received LT only [LT group]) were included in the present meta-analysis. Efficacy analysis revealed that pooled hazard ratio for overall survival (OS) between 2 groups was not significantly different (hazard ratio = 1.03; 95% confidence interval [CI]: 0.71–1.50). SPLT group had less postoperative rejection (odds ratio [OR] = 0.63, 95% CI: 0.50–0.79) and small for size syndrome (OR = 0.23, 95% CI: 0.07–0.79). SPLT group had significantly lower preoperative platelet (mean difference [MD] = −17.23, 95% CI: −19.54, −14.91), but significantly higher postoperative platelet (MD = 170.45, 95% CI: 108.33–232.56). Conversely, SPLT group had significant higher preoperative portal pressure (MD = 1.54, 95% CI: 0.75–2.33) and significant lower postoperative portal pressure (MD = −1.17, 95% CI: −2.24, −0.11). Safety analysis revealed that SPLT group had significantly longer operation time (MD = 56.66, 95% CI: 35.96–77.35), more intraoperative blood loss (MD = 1.08, 95% CI: 0.25–1.91), and more intraoperative red blood cell (RBC) transfusion (MD = 3.77, 95% CI: 3.22–4.33). Furthermore, SPLT group had significantly higher incidence of postoperative hemorrhage (OR = 3.07, 95% CI: 1.92–4.91), postoperative thrombosis (OR = 3.63, 95% CI: 1.06–12.45), and perioperative infection (OR = 2.62, 95% CI: 1.76–3.90). In addition, perioperative mortality was significantly higher in the SPLT group (OR = 3.14, 95% CI: 1.31–7.52). Postoperative hospital stay did not differ significantly between 2 groups (OR = −1.75, 95% CI: −3.66–0.16).Conclusions:Splenectomy benefits LT patients in increasing platelet count. However, splenectomy is a morbid procedure as splenectomy increases operation time, intraoperative blood loss, intraoperative RBC transfusion, and postoperative complications. Splenectomy does not improve OS but increase perioperative mortality. Therefore, splenectomy should be performed only in selective patients.

Generation of Myeloid Cells in Cancer: The Spleen Matters

“…Liver transplantation (LT) has been established as a standard treatment for patients with HCC who meet the Milan criteria. Splenectomized LT patients benefit from increased platelet counts, but they suffer risks, including increased operation time, intraoperative blood loss, intraoperative red blood cell transfusion, and postoperative complications (150). Splenectomy improves patient prognosis but only in a subgroup of patients with an increased neutrophillymphocyte ratio (NLR) and increased infiltration of CD163 + TAMs in the tumor stroma, both of which are indicative of enhanced myelopoiesis (151).…”

Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis ‐ a retrospective study

“…Nonetheless, preoperative rituximab with plasmapheresis and the success of newer generation direct-acting antiviral (DAA) agents have limited the indications for splenectomy in ABO-incompatible and HCV-positive recipients, respectively [7,8]. Furthermore, simultaneous splenectomy (SS) in the context of cirrhosis was reported to negatively affect complications such as prolonged operative time, increased blood loss, portal vein thrombosis, and post-splenectomy sepsis syndrome [9][10][11].…”

Long term changes in thrombocytopenia and leucopenia after HCV eradication with direct-acting antivirals

“…Thrombocytopenia in HCV-infected patients is thought to be due to portal hypertension-induced splenomegaly, resulting in the splenic pooling of platelets [ 23 ]. Spleen size and thrombocytopenia are thought to be associated, and meta-analyses have shown that splenectomy in addition to hepatectomy or liver transplantation improved thrombocytopenia and/or leukocytopenia compared with hepatectomy or liver transplantation alone [ 24 , 25 ]. Reduced portal hypertension following trans-jugular intrahepatic portosystemic shunt was also found to improve thrombocytopenia [ 26 , 27 ].…”