Splenectomy Before Adult Liver Transplantation: a Retrospective Study

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2017 Apr 22

PMID 28427382

Citations 2

Authors

Lingxiang Kong

Ming Li

Lei Li

Li Jiang

Jiayin Yang

Lvnan Yan

Affiliations

Soon will be listed here.

Abstract

Background: A considerable number of patients with portal hypertension (PHT) have to undergo splenectomy because they do not meet the requirements for liver transplantation (LT) or cannot find a suitable liver donor. However, it is not known whether pre-transplantation splenectomy may create occult difficulties for patients who require LT in future.

Methods: We analyzed 1059 consecutive patients who underwent adult liver transplantation (ADLT). Patients with pre-transplantation splenectomy Sp(+) and without splenectomy Sp(-) were compared using a propensity score analysis to create the best match between groups.

Results: There were no differences between patients in group Sp(+) and group Sp(-) with respect to the main post-operative infections (12.20% vs. 15.85%, P = 0.455), and the incidence of major complications (6.10% vs. 10.98%, P = 0.264). The post-operative platelet count was significantly higher in group Sp(+) (P = 0.041), while group Sp(-) had a higher rate of post-operative thrombocytopenia (91.46% vs. 74.39%, P = 0.006) and early allograft dysfunction (EAD) (23.20% vs. 10.98%, P = 0.038). The 5-year overall survival rates were similar in groups Sp(-) and Sp(+) (69.7% vs. 67.6%, P = 0.701).

Conclusions: Compared with Sp(-), the risk of infection and post-operative complications in group Sp(+) was not increased, while group Sp(-) had a higher rate of post-operative EAD. Moreover, pre-transplantation splenectomy is very effective for the prevention of thrombocytopenia after LT. Pre-transplantation splenectomy is recommended in cases with risky PHT patients without appropriate source of liver for LT.

Citing Articles

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References

Lesurtel M, Graf R, Aleil B, Walther D, Tian Y, Jochum W . Platelet-derived serotonin mediates liver regeneration. Science. 2006; 312(5770):104-7. DOI: 10.1126/science.1123842. View

Mutchnick M, Lerner E, CONN H . Effect of portacaval anastomosis on hypersplenism. Dig Dis Sci. 1980; 25(12):929-38. DOI: 10.1007/BF01308044. View

Yao F, Ferrell L, Bass N, Watson J, Bacchetti P, Venook A . Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001; 33(6):1394-403. DOI: 10.1053/jhep.2001.24563. View

Toghill P, Green S . Splenic influences on the blood in chronic liver disease. Q J Med. 1979; 48(192):613-25. View

Schmidt K, Rasmussen J, Bekker C, MADSEN P . Kinetics and in vivo distribution of 111-In-labelled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia. Scand J Haematol. 1985; 34(1):39-46. DOI: 10.1111/j.1600-0609.1985.tb00742.x. View

Chang F, Singh N, Gayowski T, Wagener M, Mietzner S, Stout J . Thrombocytopenia in liver transplant recipients: predictors, impact on fungal infections, and role of endogenous thrombopoietin. Transplantation. 2000; 69(1):70-5. DOI: 10.1097/00007890-200001150-00014. View

Kim J, Yi N, Shin W, Kim T, Lee K, Suh K . Platelet transfusion can be related to liver regeneration after living donor liver transplantation. World J Surg. 2010; 34(5):1052-8. DOI: 10.1007/s00268-010-0464-x. View

Lawrence S, Lezotte D, Durham J, Kumpe D, Everson G, Bilir B . Course of thrombocytopenia of chronic liver disease after transjugular intrahepatic portosystemic shunts (TIPS). A retrospective analysis. Dig Dis Sci. 1995; 40(7):1575-80. DOI: 10.1007/BF02285211. View

Troisi R, Colle I, Van Vlierberghe H, Hesse U, Cuomo O, de Hemptinne B . Splenectomy and liver transplantation. Transplant Proc. 2001; 33(1-2):1500-1. DOI: 10.1016/s0041-1345(00)02569-0. View

10.

Cescon M, Sugawara Y, Takayama T, Seyama Y, Sano K, Imamura H . Role of splenectomy in living-donor liver transplantation for adults. Hepatogastroenterology. 2002; 49(45):721-3. View

11.

Bleibel W, Caldwell S, Curry M, Northup P . Peripheral platelet count correlates with liver atrophy and predicts long-term mortality on the liver transplant waiting list. Transpl Int. 2013; 26(4):435-42. DOI: 10.1111/tri.12064. View

12.

Santambrogio R, Kluger M, Costa M, Belli A, Barabino M, Laurent A . Hepatic resection for hepatocellular carcinoma in patients with Child-Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication?. HPB (Oxford). 2012; 15(1):78-84. PMC: 3533715. DOI: 10.1111/j.1477-2574.2012.00594.x. View

13.

Olthoff K, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J . Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010; 16(8):943-9. DOI: 10.1002/lt.22091. View

14.

Stevenson W, Sawyer R, Pruett T . Recurrent variceal bleeding after liver transplantation--persistent left-sided portal hypertension. Transplantation. 1992; 53(2):493-5. DOI: 10.1097/00007890-199202010-00044. View

15.

Stein S, Harker L . Kinetic and functional studies of platelets, fibrinogen, and plasminogen in patients with hepatic cirrhosis. J Lab Clin Med. 1982; 99(2):217-30. View

16.

Llovet J . Updated treatment approach to hepatocellular carcinoma. J Gastroenterol. 2005; 40(3):225-35. DOI: 10.1007/s00535-005-1566-3. View

17.

Huang F, Du C, Sun M, Ning B, Luo Y, An S . [Propensity score matching in SPSS]. Nan Fang Yi Ke Da Xue Xue Bao. 2015; 35(11):1597-601. View

18.

Lesurtel M, Raptis D, Melloul E, Schlegel A, Oberkofler C, El-Badry A . Low platelet counts after liver transplantation predict early posttransplant survival: the 60-5 criterion. Liver Transpl. 2013; 20(2):147-55. DOI: 10.1002/lt.23759. View

19.

Settmacher U, Nussler N, Glanemann M, Haase R, Heise M, Bechstein W . Venous complications after orthotopic liver transplantation. Clin Transplant. 2000; 14(3):235-41. DOI: 10.1034/j.1399-0012.2000.140309.x. View

20.

Richards E, Alexander G, Calne R, Baglin T . Thrombocytopenia following liver transplantation is associated with platelet consumption and thrombin generation. Br J Haematol. 1997; 98(2):315-21. DOI: 10.1046/j.1365-2141.1997.2363056.x. View