Improved graft function in liver‐transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome?

Bárcena, Rafael; Moreno, Ana; Foruny, José Ramón; Moreno, Alberto; Sánchez, Juan; Gil-Grande, L; Blázquez, Javier; Nuño, Javier; Fortün, Jesús; Rodríguez-Gandía, Miguel Ángel; Oton, E.

doi:10.1111/j.1399-0012.2006.00516.x

Cited by 29 publications

(18 citation statements)

References 11 publications

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“…10 They also showed an improvement in peak and mean flow rates of the left and right hepatic arteries after coil embolization, which parallels the increase in PSV in our study.…”

Section: Discussionsupporting

confidence: 87%

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Doppler Ultrasonography Findings of Splenic Arterial Steal Syndrome After Liver Transplant

Uslu

Aslan²,

Töre³

et al. 2012

Exp Clin Transplant

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“…10 They also showed an improvement in peak and mean flow rates of the left and right hepatic arteries after coil embolization, which parallels the increase in PSV in our study.…”

Section: Discussionsupporting

confidence: 87%

“…However, early recognition and appropriate treatment of blood flow redirection have been shown to normalize patient outcomes. 10 Therefore, an imaging strategy to follow-up orthotopic liver transplant patients should focus on early detection of this entity. Conventional celiac angiography remains the criterion standard for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Doppler Ultrasonography Findings of Splenic Arterial Steal Syndrome After Liver Transplant

Uslu

Aslan²,

Töre³

et al. 2012

Exp Clin Transplant

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“…In the present analysis, 10% of our patients (12 of 119) without preceding banding or closure of the SA developed SASS after transplantation; all of them were treated with subsequent coil embolisation, which improves the outcome of OLT [29,30,31]. So far, a variety of parameters have been tested to predict the development of SASS after OLT [18,19].…”

Section: Discussionmentioning

confidence: 97%

Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation

et al. 2009

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The purpose of this study was to evaluate the accuracy of MDCT for preoperative assessment of hepatic vascular anatomy and the identification of liver-transplantation (OLT) patients at risk of developing subsequent splenic artery steal syndrome (SASS). A total of 145 patients with liver cirrhosis who had undergone OLT and had pre-operative three-phase MDCT (4- to 64-rows) within 100 days before OLT were enrolled retrospectively. MDCT and 3Ds were reviewed by two independent blinded observers (O1/O2). Pre-operative imaging findings were correlated with intra-operative results; findings indicative for SASS were correlated with clinical data and DSA. Among all 145 patients, 16 patients (11%) showed accessory hepatic arteries (accuracy O1/O2, 97%; with 3Ds, 100%); 32 (22%) patients had replaced hepatic arteries (accuracy O1, 97%; O2, 95%; with 3Ds, 100%; kappa = 0.87 and 0.89, P < 0.001). Among 119 patients, 12 patients developed SASS after OLT. The logistic regression model revealed the spleen volume (P = 0.0105) as a predictive factor of SASS. With spleen volumes >or=829 ml, an accuracy of 75% for prediction of SASS was obtained. MDCT with three-dimensional post-processing (3Ds) was highly accurate for pre-operative hepatic vessel evaluation in patients before OLT. In addition, spleen volume was a predictive factor for developing SASS after OLT.

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“…That study suggested that PSE improves the thrombocytopenia induced by immunologic mechanisms in cirrhotic patients. As for hemodynamic mechanisms, Barcena et al [25] reported that PSE decreased blood flow in the splenic artery and increased blood flow in the hepatic artery and superior mesenteric artery. In addition, Kato et al [26] found that the decrease in total portal blood flow and the relative increase in the mesenteric blood flow after PSE may decrease liver congestion, enhance the blood supply, and increase the supply of cytokines derived from the digestive tract.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of partial splenic embolization on platelet values for liver cirrhosis patients with thrombocytopenia

Lee

Leung

Wang

et al. 2007

WJG

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AIM:To investigate the effect of partial splenic embolization (PSE) on platelet values in liver cirrhosis patients with thrombocytopenia and to determine the effective embolization area for platelet values improvement. METHODS:Blood parameters and liver function indicators were measured on 10 liver cirrhosis patients (6 in Child-Pugh grade A and 4 in grade B) with thrombocytopenia (platelet values < 80 × 10 3 /μL) before embolization. Computed tomography scan was also needed in advance to acquire the splenic baseline. After 2 to 3 d, angiography and splenic embolization were performed. A second computed tomography scan was made to confirm the embolization area after 2 to 3 wk of embolization. The blood parameters of patients were also examined biweekly during the 1 year follow-up period. RESULTS:According to the computed tomography images after partial splenic embolization, we divided all patients into two groups: low (< 30%), and high (≥ 30%) embolization area groups. The platelet values were increased by 3 times compared to baseline levels after 2 wk of embolization in high embolization area group. In addition, there were significant differences in platelet values between low and high embolization area groups. GPT values decreased significantly in all patients after 2 wk of embolization. The improvement in platelet and GPT values still persisted until 1 year after PSE. In addition, 3 of 4 (75%) Child-Pugh grade B patients progressed to grade A after 2 mo of PSE. The complication rate in < 30% and ≥ 30% embolization area groups was 50% and 100%, respectively.

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Improved graft function in liver‐transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome?

Abstract: In HCV LT patients with chronic graft dysfunction and cholestasis the improvement in the liver function following PSE might be due to the reversal of an undiagnosed splenic artery steal syndrome related to chronic hypersplenism masked by HCV recurrence.

Cited by 29 publications

References 11 publications

Doppler Ultrasonography Findings of Splenic Arterial Steal Syndrome After Liver Transplant

Doppler Ultrasonography Findings of Splenic Arterial Steal Syndrome After Liver Transplant

Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation

Evaluation of the effect of partial splenic embolization on platelet values for liver cirrhosis patients with thrombocytopenia

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