Application of splenectomy to decompress portal pressure in left lobe living donor liver transplantation

This study was conducted to evaluate the impact of splenectomy in living donor liver transplantation (LDLT) using left lobe grafts. The two hundred and fifty LDLT cases were divided into two groups: Group-S (n = 98, simultaneous splenectomy) and Group-NS (n = 152). Group-S had significantly increase...

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Published inFukuoka igaku zasshi = Hukuoka acta medica Vol. 104; no. 9; p. 282
Main Authors Ikegami, Toru, Yoshizumi, Tomoharu, Soejima, Yuji, Ikeda, Tetsuo, Kawanaka, Hirofumi, Uchiyama, Hideaki, Yamashita, Yo-ichi, Morita, Masaru, Oki, Eiji, Saeki, Hiroshi, Mimori, Koshi, Sugimachi, Keishi, Watanabe, Masayuki, Shirabe, Ken, Maehara, Yoshihiko
Format Journal Article
LanguageEnglish
Published Japan 25.09.2013
Subjects
Adult
End Stage Liver Disease - surgery
Feasibility Studies
Female
Graft Survival
Humans
Hypertension, Portal - etiology
Hypertension, Portal - prevention & control
Liver Transplantation - adverse effects
Living Donors
Male
Middle Aged
Primary Graft Dysfunction - etiology
Primary Graft Dysfunction - prevention & control
Splenectomy
Treatment Outcome
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Summary:This study was conducted to evaluate the impact of splenectomy in living donor liver transplantation (LDLT) using left lobe grafts. The two hundred and fifty LDLT cases were divided into two groups: Group-S (n = 98, simultaneous splenectomy) and Group-NS (n = 152). Group-S had significantly increased recipient age (54.5 +/- 10.9 years vs. 46.3 +/- 17.0 years, p < 0.01), advanced liver diseases including Child class C (64.8% vs. 51.5%, p < 0.01), higher model for end-stage liver score (17.8 +/- 8.1 vs. 15.4 +/- 5.8, p < 0.01) and more patients with hospitalized status (67.4% vs. 48.0%, p < 0.01), and smaller graft volume/standard liver volume ratio (36.5 +/- 6.1% vs. 40.2 +/- 8.2%, p < 0.01). In Group-S, splenectomy decreased portal venous (PV) pressure decreased from 23.5 +/- 5.2 mmHg to 19.2 +/- 4.8 mmHg (p < 0.01). Group-S had significantly increased PV pressure at laparotomy (24.9 +/- 5.3 mmHg vs. 22.5 +/- 6.3 mmHg, p < 0.01) and decreased PV pressure at closure (16.4 +/- 3.5 mmHg vs. 18.0 +/- 4.7 mmHg, p < 0.01), compared with Group-NS. On the 14th day after LDLT, Group-S had lower total bilirubin (5.7 +/- 6.5 mg/dl vs. 8.7 +/- 8.9 mg/dl, p < 0.01) and smaller ascites output (0.4 +/- 0.7 L/day vs. 0.7 +/- 0.4 L/day, p = 0.01) than Group-NS. The cumulative 5-year graft survival rate was 86.8% in Group-S and 76.2% in Group-NS (p = 0.03). In conclusion, splenectomy had beneficial impacts on graft outcomes in left-lobe LDLT.
ISSN:0016-254X