Delayed splenic artery occlusion for treatment of established small-for-size syndrome after partial liver transplantation.
We looked at the impact of delayed splenic artery occlusion (SAO) on recipients with established small-for-size syndrome (SFSS) after partial graft liver transplantation [either from a living donor (LD) or split from a deceased donor (DD)]. Between 1999 and 2007 we performed a total of 100 partial liver transplantations in adult recipients: 66 LD transplantations and 34 DD split transplantations. Of these, 7 (7%) developed SFSS, diagnosed by the clinical features of cholestasis, coagulopathy, and ascites. Mean graft weight/recipient weight (GW/RW) ratio in these 7 recipients was 0.94%. Five of these 7 recipients underwent relaparotomy at a mean of 10 days post-transplantation to rule out a technical complication, and then intraoperative splenic artery ligation was performed. The other 2 recipients were treated radiologically by splenic artery coiling-at 9 and 13 days post-transplantation. Median serum bilirubin at the time of the splenic artery procedure was 20 mg/dL; by 3 weeks postprocedure this had decreased to 2.5 mg/dL. Of the 7 recipients with SFSS, 6 improved and eventually obtained normal graft function; 1 recipient did not improve and ultimately underwent retransplantation because of persistent cholestasis and failure to thrive. Delayed SAO represents a potential option for the treatment of recipients with established SFSS after partial liver transplantation.
Humar
Abhinav
A
Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. humar001@umn.edu
Beissel
Joy
J
Crotteau
Shaina
S
Cohen
Melissa
M
Lake
John
J
Payne
William D
WD
D000328:Adult; D005260:Female; D006801:Humans; D008026:Ligation; D008099:Liver / Q000033:anatomy & histology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013157:Splenic Artery / Q000601:surgery*; D013577:Syndrome