Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management.
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.
Geissler
Ina
I
Department of Abdominal Transplantation and Vascular Surgery, University Hospital of Leipzig, Center of Surgery, Liebigstrasse 20a, 04103 Leipzig, Germany.
Lamesch
Peter
P
Witzigmann
Helmut
H
Jost
Uwe
U
Hauss
Johann
J
Fangmann
Josef
J
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