Improved graft function in liver-transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome?
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.
Bárcena
Rafael
R
Services of Liver-Gastroenterology, Hospital Ramon y Cajal, Madrid, Spain. rbarcena.hrc@salud.madrid.org
Moreno
Ana
A
Foruny
José Ramón
JR
Moreno
Alberto
A
Sánchez
Juan
J
Gil-Grande
Luis
L
Blázquez
Javier
J
Nuño
Javier
J
Fortún
Jesús
J
Rodriguez-Gandía
Miguel Angel
MA
Otón
Elena
E
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