title: Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management.
abstract: Well-known arterial complications after liver transplantation comprise thrombosis and major stenosis, which usually necessitate a retransplantation procedure. In our institution, in a series of 165 consecutive liver transplantations, we report the first recognized case of a splenohepatic arterial steal syndrome. This is characterized by an arterial malperfusion of the hepatic graft caused by a marked diversion of blood flow to a significantly enlarged spleen, which leads to major ischemic damage of the hepatic graft. After splenectomy the perfusion through the hepatic artery increased substantially and the graft was salvaged, with a following favorable clinical course. Splenohepatic arterial steal syndrome may ultimately result in graft loss if it is falsely diagnosed or recognized too late. A post-transplantation splenectomy represents a successful therapeutic approach; alternatively a primary arterial anastomosis to the aorta prevents the development of this condition.
authors.affiliation: Department of Abdominal Transplantation and Vascular Surgery, University Hospital of Leipzig, Center of Surgery, Liebigstrasse 20a, 04103 Leipzig, Germany.
authors.forename: Ina
authors.initials: I
authors.lastname: Geissler
authors.forename: Peter
authors.initials: P
authors.lastname: Lamesch
authors.forename: Helmut
authors.initials: H
authors.lastname: Witzigmann
authors.forename: Uwe
authors.initials: U
authors.lastname: Jost
authors.forename: Johann
authors.initials: J
authors.lastname: Hauss
authors.forename: Josef
authors.initials: J
authors.lastname: Fangmann
mesh_terms: D000328:Adult; D001158:Arteries / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D006499:Hepatic Artery / Q000601:surgery*; D006527:Hepatolenticular Degeneration / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D013154:Spleen / Q000098:blood supply*; D013156:Splenectomy; D013577:Syndrome