Hypersplenism after living donor liver transplantation.
OBJECTIVE
It has not determined whether post-transplant persistent hypersplenism (PTPH) occurs after living donor liver transplantation (LDLT).


METHODS
One hundred and ninety-four patients who survived more than 6 months after LDLTs were examined for the evaluation to determine the incidence of PTPH (leukocyte counts <3,500/microL and/or platelet counts <7.5 x 10(4)/microL). In addition, 154 patients without a splenectomy were evaluated for the risk factors for PTPH.


RESULTS
The incidence of PTPH was 20.1% (n=31/154), and the occurrence ranged between 1.1 and 9.9 years after the LDLT, with the mean follow-up periods of 3.3+/-2.5 years. Multivariate analysis showed that portal pressure >30 mmHg at the time of the laparotomy (p<0.01) and post-LDLT small for size syndrome (p<0.01) are risk factors for PTPH. For those with severe portal hypertension (>30 mmHg at laparotomy), the splenectomy tended to give better survival rate (p=0.09) without increasing the rate of septic complications.


CONCLUSIONS
Hypersplenism did persist in a proportion of patients after LDLT. A high-risk for PTPH, especially severe portal hypertension, may be an indication for a splenectomy during LDLT in order to achieve uncomplicated post-transplant recovery.
Ikegami
Toru
T
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.ac.jp
Soejima
Yuji
Y
Taketomi
Akinobu
A
Kawanaka
Hirofumi
H
Yoshizumi
Tomoharu
T
Shimada
Mitsuo
M
Maehara
Yoshihiko
Y
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006971:Hypersplenism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015994:Incidence; D017093:Liver Failure / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome