Open AccessSplenic devascularization can replace splenectomy during adult living donor liver transplantation – a historical cohort study
Author(s) -
Moon DeokBog,
Lee SungGyu,
Hwang Shin,
Ahn ChulSoo,
Kim KiHun,
Ha TaeYong,
Song GiWon,
Jung DongHwan,
Park GilChun,
Yoon YoungIn,
Cho HwuiDong,
Kwon JaeHyun,
Jung YongKyu,
Ha SuMin
Publication year - 2019
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.13405
Subject(s) - medicine , splenectomy , pancytopenia , splenic artery , surgery , complication , liver transplantation , transplantation , spleen , bone marrow
Summary Simultaneous splenectomy (SSPX) in adult living donor liver transplantation (ALDLT) has definitely beneficial roles such as portal flow modulation in small‐for‐size graft and correction of hypersplenism‐related pancytopenia, and so on, but disastrous complications after SSPX often occur. For the first time, we devised unique and innovative splenic devascularization (SDV) procedure to alleviated untoward effects of SSPX but to maintain its benefits for the indicated patients. From April 2013 to December 2014, 520 recipients underwent ALDLT, and the SSPX and SDV were simultaneously performed in 62 (11.9%) and 61 (11.7%) patients, respectively. The most common indication was hypersplenism‐related pancytopenia ( n = 101), small‐for‐size graft ( n = 14), hepatitis C virus (HCV) ( n = 7), and splenic artery aneurysm ( n = 1). Postoperative small‐for‐size graft syndrome (SFSS) was absent in both SSPX and SDV, and preoperative pancytopenia was improved in both groups since postoperative 1 week, although SSPX was more substantial than SDV. Preoperative splenic volume (706.2 ± 282.9 ml) after SDV significantly decreased to 425.5 ± 204.4 ml on 1 month, respectively. In contrast to SDV, SSPX resulted in longer operation time and higher incidence of postoperative complications including mortality. In conclusion, SDV can replace SSPX during ALDLT without hampering its beneficial roles seriously, but get rid of splenectomy‐related lethal complication.