Is Splenectomy Always Effective on Liver Regeneration of Extended Left Lobe Graft After Living Donor Liver Transplantation?

Abstract

Background/Aims: The effect of splenectomy on the liver regeneration of a partial graft after living donor liver transplantation (LDLT) is controversial. In recent years, some studies have shown that platelets have strong effects on promoting liver regeneration, but not with a smallfor-size liver graft. This study aimed to validate the effects of splenectomy on liver regeneration rate after LDLT with extended left lobe graft with the middle hepatic vein. Methodology: Of 312 LDLT to date, 32 adult patients at Nagasaki University Hospital (Nagasaki, Japan) transplanted with an extended left lobe graft with middle hepatic vein between April 2013 and April 2019 were retrospectively assessed. In our department, the preoperative platelet count indicated for splenectomy is 50,000/ L. Overall, 13 and 19 patients were included in the splenectomy and without splenectomy groups, respectively. We examined the relations hip between splenectomy and liver volume increase, and postoperative platelet count on the 1st, 3rd, 5th, and 7th postoperative day. The liver volume 1 month (1MVol) after LDLT was estimated using a 3D image analysis system. Results: ROC curve analysis showed the spleen volume threshold for significant volume increase (1MVol/graft weight 2) was 440ml. With regard to 1MVol, no significant difference was observed between the splenectomy and without splenectomy groups. However, in the splenectomy group, recipients with a large spleen (more than 440 ml) led to higher liver volume increase than in those with a small spleen. Platelet count significantly increased from postoperative day 14 in the splenectomy group regardless of the size of the spleen. Conclusions: Simultaneous splenectomy does not always have an effect on liver regeneration in extended left lobe graft LDLT. However, for LDLT recipients with large spleen volume, graft volume increase was affected, probably through vigorous portal venous blood flow but not plateletderived factors.

Outcomes of living donor liver transplant recipients receiving grafts with the graft-to-recipient weight ratio less than 0.6%: A matched pair analysis

“…[18][19][20] In cases with a right lobe graft that contained the inferior right hepatic vein (iRHV), the iRHV was reconstructed when its diameter exceeded 5 mm. [21] As we described, [22,23] splenectomy was indicated when the platelet count at the time of transplantation was < 50,000/µL due to hypersplenism. Because we started to perform splenectomy based on donor age, GV/SLV, and portal venous pressure after graft implantation in April 2021, splenectomy with the intent to modulate the portal inflow was not performed during the study period.…”