Highlights
- •Simultaneous splenectomy improved clinical outcomes in LDLT recipients after propensity-score matching.
- •Univariate analysis revealed that splenectomy was the only factor associated with graft mortality after LDLT.
- •Simultaneous splenectomy can be used to overcome small-for-size graft syndrome.
- •It can also be recommended for patients with portal hypertension or high portal pressure after reperfusion in LDLT.
Background & Aims
Small-for-size graft (SFSG) syndrome is a major cause of graft loss after living donor
liver transplantation (LDLT). Splenectomy (Spx) is an option to prevent this catastrophic
complication, but its effect remains controversial. Herein, we aimed to elucidate
the effect of simultaneous Spx on graft function and long-term outcomes after LDLT.
Methods
Three hundred and twenty patients were divided into 2 groups: those undergoing (n =
258) and those not undergoing (n = 62) simultaneous Spx. To overcome selection bias,
propensity score matching (PSM) was performed (n = 50 in each group).
Results
Before PSM, recipients undergoing simultaneous Spx showed better graft function on
post-operative day (POD) 7 and 14, as well as lower sepsis frequency within 6 months
after LDLT and better graft survival rates compared to those not undergoing Spx. After
PSM, compared to patients not undergoing Spx, those undergoing Spx had a lower frequency
of early graft dysfunction on POD 7 (p = 0.04); a lower frequency of SFSG syndrome (p = 0.01), lower serum total bilirubin levels (p = 0.001), and lower international normalized ratio (p = 0.004) on POD 14; lower sepsis frequency within 6 months after LDLT (p = 0.02), and better graft survival rates (p = 0.04). Univariate analysis revealed that not undergoing Spx (hazard ratio 3.06;
95% CI 1.07–11.0; p = 0.037) was the only risk factor for graft loss after LDLT.
Conclusions
Simultaneous Spx may prevent SFSG syndrome and is a predictive factor for graft survival
after LDLT. Simultaneous Spx is recommended when a small graft (≤35% of standard liver
weight) is predicted preoperatively, or for patients with portal hypertension or high
portal pressure (above 20 mmHg) after reperfusion in LDLT.
Lay summary
Living donor liver transplantation (LDLT) for patients with acute or chronic liver
failure is an alternative to overcome the deceased donor shortage. The potential mismatch
between graft and body size is a problem that needs to be solved for LDLT recipients.
Herein, we evaluated the impact of simultaneous splenectomy and showed that it was
associated with favorable outcomes in patients undergoing LDLT.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: August 19, 2020
Accepted:
August 12,
2020
Received in revised form:
July 28,
2020
Received:
August 11,
2018
Identification
Copyright
© 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
