Hypersplenism after living donor liver transplantation.

Abstract

BACKGROUND/AIMS:

It has not determined whether post-transplant persistent hypersplenism (PTPH) occurs after living donor liver transplantation (LDLT).

METHODOLOGY:

One hundred and ninety-four patients who survived more than 6 months after LDLTs were examined for the evaluation to determine the incidence of PTPH (leukocyte counts <3,500/microL and/or platelet counts <7.5 x 10(4)/microL). In addition, 154 patients without a splenectomy were evaluated for the risk factors for PTPH.

RESULTS:

The incidence of PTPH was 20.1% (n=31/154), and the occurrence ranged between 1.1 and 9.9 years after the LDLT, with the mean follow-up periods of 3.3+/-2.5 years. Multivariate analysis showed that portal pressure >30 mmHg at the time of the laparotomy (p<0.01) and post-LDLT small for size syndrome (p<0.01) are risk factors for PTPH. For those with severe portal hypertension (>30 mmHg at laparotomy), the splenectomy tended to give better survival rate (p=0.09) without increasing the rate of septic complications.

CONCLUSIONS:

Hypersplenism did persist in a proportion of patients after LDLT. A high-risk for PTPH, especially severe portal hypertension, may be an indication for a splenectomy during LDLT in order to achieve uncomplicated post-transplant recovery.

• Authors: Toru Ikegami, Yuji Soejima, Akinobu Taketomi, Hirofumi Kawanaka, Tomoharu Yoshizumi, Mitsuo Shimada, Yoshihiko Maehara
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2009 May-Jun Vol. 56 Issue 91-92 Pg. 778-82 ISSN: 0172-6390 [Print] Greece
• PMID: 19621701 (Publication Type: Journal Article)

Topics

• Adult
• Female
• Follow-Up Studies
• Graft Survival
• Humans
• Hypersplenism (diagnosis, epidemiology, therapy)
• Incidence
• Liver Failure (complications, pathology, surgery)
• Liver Transplantation
• Living Donors
• Male
• Middle Aged
• Risk Factors
• Treatment Outcome