Possible benefit of splenectomy in liver transplantation for autoimmune hepatitis

Yang, Xu; Liu, Dejie; Meng, Fanying; Li, Guang-Bing; Li, Jun

doi:10.1016/s1499-3872(14)60256-3

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…The recurrence rate after transplantation may differ in different races; this question requires further investigation. Splenectomy may inhibit the recurrence of AIH after liver transplantation 84. In a mouse AIH model, by removing central Treg cells, splenectomy prolonged the effects of a corticosteroid 85.…”

Section: Treatmentmentioning

confidence: 99%

Autoimmune hepatitis: current challenges and future prospects

Aizawa¹,

Hokari²

2017

CEG

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Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by high levels of aminotransferases and autoantibodies, hypergammaglobulinemia, and interface hepatitis. AIH affects all races and all ages worldwide, regardless of sex, although a preponderance of females is a constant finding. The etiology of AIH has not been completely elucidated, but immunogenetic background and environmental parameters may contribute to its development. The most important genetic factor is human leukocyte antigens (HLAs), especially HLA-DR, whereas the role of environmental factors is not completely understood. Immunologically, disruption of the immune tolerance to autologous liver antigens may be a trigger of AIH. The diagnosis of classical AIH is fairly easy, though not without pitfalls. In contrast, the diagnosis of atypical AIH poses great challenges. There is confusion as to the definition of the disease entity and its boundaries in the diagnosis of overlap syndrome, drug-induced autoimmune hepatitis, and AIH with concomitant nonalcoholic fatty liver disease (NAFLD) or chronic hepatitis C. Centrilobular zonal necrosis is now included in the histological spectrum of AIH. However, the definition and the significance of AIH presenting with centrilobular zonal necrosis have not been examined extensively. In ~20% of AIH patients who are treated for the first time with standard therapy, remission is not achieved. The development of more effective and better tolerated novel therapies is an urgent need. In this review, we discuss the current challenges and the future prospects in relation to the diagnosis and treatment of AIH, which have been attracting considerable recent attention.

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Section: Treatmentmentioning

confidence: 99%

Autoimmune hepatitis: current challenges and future prospects

Aizawa¹,

Hokari²

2017

CEG

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“…The reported incidence of PVT after SP is higher than those reported in the literature, since Settmacher and Xu published an incidence of about 10%. 30,31 Many factors explain our results. Three patients had a medical history of thromboembolic disease and two patients had portal revascularization on ectopic varices or using a venous graft.…”

Section: Discussionmentioning

confidence: 91%

Splenectomy during whole liver transplantation: a morbid procedure which does not adversely impact long-term survival

Golse

Mohkam

Rode

et al. 2017

HPB

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“…[ 24 , 61 – 63 ] Previous study has also reported splenectomy could reduce the incidence of HBV recurrence after LT for HBV-related ESLDs with severe hypersplenism and splenomegaly. [ 9 ] Furthermore, splenectomy might be beneficial for preventing autoimmune hepatitis relapse after LT. [ 64 ]…”

Section: Discussionmentioning

confidence: 99%

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

He¹,

Liu

Peng³

et al. 2018

Medicine

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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.

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Possible benefit of splenectomy in liver transplantation for autoimmune hepatitis

Cited by 7 publications

References 24 publications

Autoimmune hepatitis: current challenges and future prospects

Autoimmune hepatitis: current challenges and future prospects

Splenectomy during whole liver transplantation: a morbid procedure which does not adversely impact long-term survival

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

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