Liver Transplantation with Simultaneous Splenectomy Increases Risk of Cancer Development and Mortality in Hepatocellular Carcinoma Patients

Overview

Journal World J Gastrointest Surg

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2022 Oct 3

PMID 36185566

Authors

Hsiu-Lung Fan

Chung-Bao Hsieh

Shih-Ming Kuo

Teng-Wei Chen

Affiliations

Soon will be listed here.

Abstract

Background: Splenectomy has previously been found to increase the risk of cancer development, including lung, non-melanoma skin cancer, leukemia, lymphoma, Hodgkin's lymphoma, and ovarian cancer. The risk of cancer development in liver transplantation (LT) with simultaneous splenectomy remains unclear.

Aim: To compare hepatocellular carcinoma (HCC) recurrence and malignancy between patients undergoing LT with and without simultaneous splenectomy.

Methods: We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with ( = 35) and without ( = 85) simultaneous splenectomy in the Tri-Service General Hospital. Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established. The comparison of the group survival status and group cancer-free status was done by generating Kaplan-Meier survival curves and log-rank tests.

Results: The splenectomy group had more hepatitis C virus infection, lower platelet count, higher -fetoprotein level, and longer operating time. Splenectomy and age were both positive independent factors for prediction of cancer development [hazard ratio (HR): 2.560 and 1.057, respectively, < 0.05]. Splenectomy and hypertension were positive independent factors for prediction of mortality. (HR: 2.791 and 2.813 respectively, < 0.05). The splenectomy group had a significantly worse cancer-free survival (CFS) and overall survival (OS) curve compared to the non-splenectomy group (5-year CFS rates: 53.4% 76.5%, = 0.003; 5-year OS rate: 68.1 89.3, = 0.002).

Conclusion: Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

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