title: Application of splenectomy to decompress portal pressure in left lobe living donor liver transplantation.
abstract: This study was conducted to evaluate the impact of splenectomy in living donor liver transplantation (LDLT) using left lobe grafts. The two hundred and fifty LDLT cases were divided into two groups: Group-S (n = 98, simultaneous splenectomy) and Group-NS (n = 152). Group-S had significantly increased recipient age (54.5 +/- 10.9 years vs. 46.3 +/- 17.0 years, p < 0.01), advanced liver diseases including Child class C (64.8% vs. 51.5%, p < 0.01), higher model for end-stage liver score (17.8 +/- 8.1 vs. 15.4 +/- 5.8, p < 0.01) and more patients with hospitalized status (67.4% vs. 48.0%, p < 0.01), and smaller graft volume/standard liver volume ratio (36.5 +/- 6.1% vs. 40.2 +/- 8.2%, p < 0.01). In Group-S, splenectomy decreased portal venous (PV) pressure decreased from 23.5 +/- 5.2 mmHg to 19.2 +/- 4.8 mmHg (p < 0.01). Group-S had significantly increased PV pressure at laparotomy (24.9 +/- 5.3 mmHg vs. 22.5 +/- 6.3 mmHg, p < 0.01) and decreased PV pressure at closure (16.4 +/- 3.5 mmHg vs. 18.0 +/- 4.7 mmHg, p < 0.01), compared with Group-NS. On the 14th day after LDLT, Group-S had lower total bilirubin (5.7 +/- 6.5 mg/dl vs. 8.7 +/- 8.9 mg/dl, p < 0.01) and smaller ascites output (0.4 +/- 0.7 L/day vs. 0.7 +/- 0.4 L/day, p = 0.01) than Group-NS. The cumulative 5-year graft survival rate was 86.8% in Group-S and 76.2% in Group-NS (p = 0.03). In conclusion, splenectomy had beneficial impacts on graft outcomes in left-lobe LDLT.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. tikesurg@surg2.med.kyushu-u.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Yo-ichi
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.affiliation: Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu 874-0838, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Mimori
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugimachi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000517:prevention & control*; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000517:prevention & control; D013156:Splenectomy; D016896:Treatment Outcome