Open AccessEvaluation of safety of concomitant splenectomy in living donor liver transplantation: a retrospective study
Author(s) -
Badawy Amr,
Hamaguchi Yuhei,
Satoru Seo,
Kaido Tochimi,
Okajima Hideaki,
Uemoto Shinji
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12985
Subject(s) - medicine , splenectomy , concomitant , portal vein thrombosis , liver transplantation , surgery , bacteremia , transplantation , gastroenterology , mortality rate , retrospective cohort study , thrombosis , spleen , microbiology and biotechnology , biology , antibiotics
Summary In Asian countries, concomitant splenectomy in living donor liver transplantation ( LDLT ) is indicated to modulate the portal vein pressure in the small‐sized graft to protect against small for size syndrome. While concomitant splenectomy in deceased donor liver transplantation is almost contraindicated based on Western Reports of increased mortality and morbidity rate due to septic complications, there are few studies about that in LDLT . So, we retrospectively investigated the clinical outcome of adult LDLT at Kyoto University Hospital from July 2010 to July 2016. We divided the patients ( n = 164) into those with concomitant splenectomy ( n = 88) and those without ( n = 76). The splenectomy group showed significantly increased operative time and intraoperative blood loss ( P = 0.008, P = 0.0007, respectively), and significantly higher rate of postoperative splenic vein thrombosis and cytomegalovirus infection ( P = 0.03, P = 0.016, respectively). However, there were no significant differences between the two groups regarding the incidence of postoperative hemorrhage ( P = 0.06), post‐transplant bacteremia ( P = 0.38), infection‐related mortality rates ( P = 0.8), acute rejection ( P = 0.87), and patient and graft survival ( P = 0.66, P = 0.67 respectively); finally, model for end‐stage liver disease score above 30 was an independent predictor for infection‐related mortality post‐transplant ( HR = 5.99, 95% CI = 2.15–16.67, P = 0.001). In conclusion, concomitant splenectomy in LDLT can be safely performed when indicated.