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Delayed splenic artery occlusion for treatment of established small‐for‐size syndrome after partial liver transplantation
Author(s) -
Humar Abhinav,
Beissel Joy,
Crotteau Shaina,
Cohen Melissa,
Lake John,
Payne William D.
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21636
Subject(s) - medicine , liver transplantation , splenic artery , surgery , cholestasis , transplantation , failure to thrive , artery , gastroenterology
We looked at the impact of delayed splenic artery occlusion (SAO) on recipients with established small‐for‐size syndrome (SFSS) after partial graft liver transplantation [either from a living donor (LD) or split from a deceased donor (DD)]. Between 1999 and 2007 we performed a total of 100 partial liver transplantations in adult recipients: 66 LD transplantations and 34 DD split transplantations. Of these, 7 (7%) developed SFSS, diagnosed by the clinical features of cholestasis, coagulopathy, and ascites. Mean graft weight/recipient weight (GW/RW) ratio in these 7 recipients was 0.94%. Five of these 7 recipients underwent relaparotomy at a mean of 10 days post‐transplantation to rule out a technical complication, and then intraoperative splenic artery ligation was performed. The other 2 recipients were treated radiologically by splenic artery coiling—at 9 and 13 days post‐transplantation. Median serum bilirubin at the time of the splenic artery procedure was 20 mg/dL; by 3 weeks postprocedure this had decreased to 2.5 mg/dL. Of the 7 recipients with SFSS, 6 improved and eventually obtained normal graft function; 1 recipient did not improve and ultimately underwent retransplantation because of persistent cholestasis and failure to thrive. Delayed SAO represents a potential option for the treatment of recipients with established SFSS after partial liver transplantation. Liver Transpl 15:163–168, 2009. © 2009 AASLD.