Simultaneous Splenectomy Selectively Suggested in Living Donor Liver Transplantation

Simultaneous splenectomy may prevent small-for-size graft syndrome in adults with a living donor liver transplantation.

Simultaneous splenectomy may prevent small-for-size graft syndrome and can predict graft survival in adults who have had living donor liver transplantation, according to research reported in the Journal of Hepatology.

The investigators sought to compare graft function and long-term outcomes of splenectomy with no portal flow modulation during living donor liver transplantation in adults. A total of 320 patients were categorized into 2 groups: those with splenectomy (n=258; mean age, 54.4±10.8 years; 41.9% men) and those without splenectomy (n=62; mean age, 52.2±13.2 years; 43.6% men).

The researchers found that participants with simultaneous splenectomy had better graft function on postoperative days 7 and 14, as well as lower sepsis frequency within 6 months after living donor liver transplantation. These patients also had better graft survival rates compared with those without splenectomy before propensity score matching.

After matching, compared with participants without splenectomy, those with simultaneous splenectomy had lower early graft dysfunction frequency on postoperative day 7 (P =.04), lower small-for-size graft syndrome frequency (P =.01), lower serum total bilirubin levels (P =.001), and lower international normalized ratio (P =.004) on postoperative day 14, lower sepsis (P =.02) frequency within 6 months after living donor liver transplantation, and better graft survival rates (P =.04).

On univariate analysis, researchers identified absence of splenectomy as the only risk factor for graft loss after living donor liver transplantation (hazard ratio 3.06; 95% CI, 1.07-11.0; P =.037).

“Simultaneous splenectomy was associated with remarkably better graft function and prognosis in adult [living donor liver transplantation] recipients,” the study authors stated. “Splenectomy was also a graft prognostic factor after [living donor liver transplantation].”

Study limitations include the retrospective design and relatively small sample size, as well as the lack of balance in several characteristics, such as body mass index and operation time in the matched sample.

“Simultaneous splenectomy is recommended when a small graft (graft weight/standard liver weight 35% or less) is predicted preoperatively, or for patients with portal hypertension or high portal pressure (above 20 mm Hg) after reperfusion in [living donor liver transplantation],” the researchers concluded.

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Yoshizumi T, Itoh S, Shimokawa M, et al. Simultaneous splenectomy improves outcomes after adult living donor liver transplantation [published online August 19, 2020]. J Hepatol. doi: 10.1016/j.jhep.2020.08.017