Splenectomy before adult liver transplantation: a retrospective study.

Abstract

BACKGROUND:

A considerable number of patients with portal hypertension (PHT) have to undergo splenectomy because they do not meet the requirements for liver transplantation (LT) or cannot find a suitable liver donor. However, it is not known whether pre-transplantation splenectomy may create occult difficulties for patients who require LT in future.

METHODS:

We analyzed 1059 consecutive patients who underwent adult liver transplantation (ADLT). Patients with pre-transplantation splenectomy Sp(+) and without splenectomy Sp(-) were compared using a propensity score analysis to create the best match between groups.

RESULTS:

There were no differences between patients in group Sp(+) and group Sp(-) with respect to the main post-operative infections (12.20% vs. 15.85%, P = 0.455), and the incidence of major complications (6.10% vs. 10.98%, P = 0.264). The post-operative platelet count was significantly higher in group Sp(+) (P = 0.041), while group Sp(-) had a higher rate of post-operative thrombocytopenia (91.46% vs. 74.39%, P = 0.006) and early allograft dysfunction (EAD) (23.20% vs. 10.98%, P = 0.038). The 5-year overall survival rates were similar in groups Sp(-) and Sp(+) (69.7% vs. 67.6%, P = 0.701).

CONCLUSIONS:

Compared with Sp(-), the risk of infection and post-operative complications in group Sp(+) was not increased, while group Sp(-) had a higher rate of post-operative EAD. Moreover, pre-transplantation splenectomy is very effective for the prevention of thrombocytopenia after LT. Pre-transplantation splenectomy is recommended in cases with risky PHT patients without appropriate source of liver for LT.

• Authors: LingXiang Kong, Ming Li, Lei Li, Li Jiang, Jiayin Yang, Lvnan Yan
• Journal: BMC surgery (BMC Surg) Vol. 17 Issue 1 Pg. 44 (Apr 20 2017) ISSN: 1471-2482 [Electronic] England
• PMID: 28427382 (Publication Type: Journal Article)

Topics

• Adult
• End Stage Liver Disease (surgery)
• Female
• Humans
• Hypertension, Portal (complications, mortality, surgery)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Platelet Count
• Postoperative Complications (prevention & control)
• Propensity Score
• Retrospective Studies
• Splenectomy (adverse effects)
• Survival Rate
• Thrombocytopenia (prevention & control)