title: Improved graft function in liver-transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome?
abstract: OBJECTIVE
  To describe the functional effect of partial splenic embolization (PSE) in liver-transplanted (LT) patients with hypersplenism and hepatitis C virus (HCV) recurrence.
  
  
  METHODS
  From May 2002 to May 2005, five LT patients with persistent hypersplenism, viral recurrence and graft dysfunction underwent PSE prior to pegylated interferon/ribavirin (peg-IFN/RBV).
  
  
  RESULTS
  The mean splenic size was 19.5 cm (16-21) and there was evidence of an enlarged splenic artery (10.7+/-1 mm). PSE produced a median splenic infarction of 90% and a significant reduction in the splenic artery diameter to 5.8+/-0.4 mm (p=0.04). PSE significantly improved hematologic parameters, bilirubin levels, prothrombin activity, international normalized ratio and the Model for End-stage Liver Disease (MELD) score despite high HCV-RNA (6.2 log10 IU/mL). It was demonstrated histologic amelioration of ischemic changes in all subjects. PSE allowed the safe use of full-dose peg-IFN plus RBV in all subjects.
  
  
  CONCLUSIONS
  In HCV LT patients with chronic graft dysfunction and cholestasis the improvement in the liver function following PSE might be due to the reversal of an undiagnosed splenic artery steal syndrome related to chronic hypersplenism masked by HCV recurrence.
authors.affiliation: Services of Liver-Gastroenterology, Hospital Ramon y Cajal, Madrid, Spain. rbarcena.hrc@salud.madrid.org
authors.forename: Rafael
authors.initials: R
authors.lastname: Bárcena
authors.forename: Ana
authors.initials: A
authors.lastname: Moreno
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Foruny
authors.forename: Alberto
authors.initials: A
authors.lastname: Moreno
authors.forename: Juan
authors.initials: J
authors.lastname: Sánchez
authors.forename: Luis
authors.initials: L
authors.lastname: Gil-Grande
authors.forename: Javier
authors.initials: J
authors.lastname: Blázquez
authors.forename: Javier
authors.initials: J
authors.lastname: Nuño
authors.forename: Jesús
authors.initials: J
authors.lastname: Fortún
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Rodriguez-Gandía
authors.forename: Elena
authors.initials: E
authors.lastname: Otón
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013154:Spleen / Q000098:blood supply*; D014652:Vascular Diseases / Q000209:etiology* / Q000628:therapy; D019562:Viral Load