title: The impact of splenectomy or splenic artery ligation on the outcome of a living donor adult liver transplantation using a left lobe graft.
abstract: 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.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. mshimada@surg2.med.kyushu-u.ac.jp
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Hideki
authors.initials: H
authors.lastname: Ijichi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yonemura
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Satoko
authors.initials: S
authors.lastname: Shiotani
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Takahiro
authors.initials: T
authors.lastname: Terashi
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Suehiro
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: 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