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Delayed splenic artery occlusion for treatment of established small-for-size syndrome after partial liver transplantation.

Abstract
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.
AuthorsAbhinav Humar, Joy Beissel, Shaina Crotteau, Melissa Cohen, John Lake, William D Payne
JournalLiver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 15 Issue 2 Pg. 163-8 (Feb 2009) ISSN: 1527-6473 [Electronic] United States
PMID19177447 (Publication Type: Journal Article)
Copyright(c) 2009 AASLD.
Topics
  • Adult
  • Female
  • Humans
  • Ligation
  • Liver (anatomy & histology)
  • Liver Transplantation (adverse effects, methods)
  • Living Donors
  • Male
  • Organ Size
  • Postoperative Complications
  • Reoperation
  • Retrospective Studies
  • Splenic Artery (surgery)
  • Syndrome

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