Splenectomy is not indicated in living donor liver transplantation

Abstract

Simultaneous splenectomy (SPX) is preferentially performed in living donor liver transplantation (LDLT) to modulate portal flow; increase postoperative platelet count, especially among those with hepatitis C virus (HCV) infection; and modulate the immunologic status in ABO-incompatible cases. The negative effects of the procedure, however, are not well established. Records of 395 LDLTs performed at our institution, including 169 (42.8%) patients with simultaneous SPX and 226 (57.2%) patients with spleen preservation, were reviewed with special reference to the simultaneous SPX cases. The most common indication for SPX was HCV-related disease (n = 114), followed by low preoperative platelet count (n = 52), and other reasons (n = 3). Simultaneous splenectomy did not increase the platelet count in the early postoperative period, but the incidence of reoperation for postoperative hemorrhage was increased, mainly at the SPX site, within the first week. In addition, the operative time, intraoperative blood loss, and incidence of lethal infectious disease were significantly higher in the SPX group, whereas the incidence of small-for-size syndrome was comparable between groups. Finally, SPX was an independent predictor for both postoperative hemorrhage (odds ratio [OR] = 2.451; 95% confidence interval [CI] = 1.285-4.815; P = 0.006) and lethal infectious complication (OR = 3.748; 95% CI = 1.148-14.001; P = 0.03). In conclusion, on the basis of the present findings, we do not recommend simultaneous SPX in LDLT. Liver Transplantation 22 1526-1535 2016 AASLD.

Is Portal Venous Pressure Modulation Still Indicated for All Recipients in Living Donor Liver Transplantation?

“…Because PHT is not the only prognostic factor in ALDLT, we need to consider PHT along with other clinical factors based on the latest findings. In recent years, Ito et al reported that simultaneous splenectomy was not necessary in ALDLT . Because splenectomy has been regarded as a key to PVP regulation, its validity needed to be reconfirmed in our ALDLT series.…”

Impact of imbalanced graft-to-spleen volume ratio on outcomes following living donor liver transplantation in an era when simultaneous splenectomy is not typically indicated

“…Transfused fresh-frozen plasma, U 10 (6-16) 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) .853…”

“…1 Recently, Gyoten et al 2 suggested that preoperative assessment of GSVR can be used to indicate the need for splenectomy (SPX) before reperfusion to prevent PHT. 6,7 Additionally, recent advances in interferon (IFN)-free directacting antiviral agents (DAAs) 8 and rituximab induction 9 have made SPX unnecessary for hepatitis C virus (HCV)-positive recipients and ABO-incompatible patients. In partial LT, the reduction in the liver vasculature increases portal venous pressure (PVP) in the early phase, but in the later phase, the liver graft regenerates to adapt to the persistent recipient hemodynamic environment with a gradual improvement of splenomegaly.…”

“…even a GSVR > 0.70 g/mL; and (2) patients with a GSVR ≤ 0.70 g/mL regardless of PVP. However, considering that the indications for SPX vary according to the institutions in clinical settings,4,7,16,38 the results represent real-world experience. The high risk patients here indicate the recipients who receive grafts from either ABO-incompatible donors or donors age ≥45 years 16.…”

Thrombocytopenia in Liver Transplant

“…In a recently published study recording 169 patients who underwent living-related LT with splenectomy [14], the authors found that concomitant splenectomy with LT surgery did not increase platelet count in the early postoperative period but they had more reinterventions due to hemorrhage, the operative time was longer, intraoperative blood loss was higher, and the incidence of lethal infectious disease was higher when compared to patients not having splenectomy during living donor LT.…”