The impact of splenectomy or splenic artery ligation on the outcome of a living donor adult liver transplantation using a left lobe graft.
OBJECTIVE
The aim of this study was to clarify the impact of splenectomy or splenic artery ligation on the outcome in living donor adult liver transplantation (LDALT) using a left lobe graft.


METHODS
Forty-eight LDALT cases using a left lobe graft were enrolled in this study. The patients were classified into two groups: Group A (n=40), in which neither a splenectomy nor a splenic artery ligation was performed, and Group B (n=8), in which a splenectomy (n=6) or a splenic artery ligation (n=2) was performed. Indications for splenectomy were as follows: 1) demonstrating a hypersplenism and/or 2) having splenic aneurysms.


RESULTS
None of the patients receiving a splenectomy or a splenic artery ligation experienced any septic complication in this series. The graft-recipient weight ratio in group B tended to be smaller than in group A. In group B, all patients were classified into Child's class C or B. The incidence of esophageal varices in group B was significantly higher than in group A. Moreover, the platelet count and the white blood cell count in group B were significantly lower than in group A. No statistical difference was found in postoperative functional cholestasis and intractable ascites. None of the participants in group B experienced both postoperative hyperbilirubinemia and intractable ascites, which were characterized as a small-for-size graft after LDALT. The patient survival rate in group B seems to be better than in group A. In a majority of the cases the portal pressure as well as the portal vein flow after a splenectomy decreased in comparison to that before the splenectomy.


CONCLUSIONS
Splenectomy or splenic artery ligation is considered to be beneficial for improving the outcome in LDALT using a left lobe graft.
Shimada
Mitsuo
M
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. mshimada@surg2.med.kyushu-u.ac.jp
Ijichi
Hideki
H
Yonemura
Yusuke
Y
Harada
Noboru
N
Shiotani
Satoko
S
Ninomiya
Mizuki
M
Terashi
Takahiro
T
Yoshizumi
Tomoharu
T
Soejima
Yuji
Y
Suehiro
Taketoshi
T
Maehara
Yoshihiko
Y
D000328:Adult; D005260:Female; D006801:Humans; D008026:Ligation; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013156:Splenectomy; D013157:Splenic Artery; D016896:Treatment Outcome