title: Spleen stiffness can non-invasively assess resolution of portal hypertension after liver transplantation.
abstract: OBJECTIVE
  Spleen stiffness can be measured by transient elastography. Recent studies have shown that spleen stiffness correlates with hepatic venous pressure gradient and can predict oesophageal varices. Elevated spleen stiffness in cirrhosis has been attributed to splenic tissue hyperplasia and fibrosis, portal hypertension and its consequent hyperdynamic circulation. The aim of this study was to investigate changes to spleen stiffness after orthotopic liver transplantation (OLT) when portal hypertension resolves.
  
  
  METHODS
  Twenty-one patients awaiting OLT were studied prospectively, while 11 post-transplant patients were recruited as controls. Spleen and liver stiffness were measured with Fibroscan before and at 2-8 weeks after OLT. Criteria applied for spleen stiffness measurement were similar to liver stiffness (≥10 measurements; ≥60% success rate; interquartile range, IQR <30% of median).
  
  
  RESULTS
  Spleen stiffness was significantly higher before OLT compared to post-transplant patients [75.0 (63.9-75.0) kPa vs. 28.4 (22.0-37.5) kPa; P < 0.0001]. For patients awaiting OLT, 90% (19/21) had oesophageal varices (endoscopically or radiologically). In patients who underwent liver transplantation, spleen stiffness decreased significantly from a median of 75.0 (62.0-75.0) kPa before OLT, to 41.9 (27.0-47.4) kPa at 2 weeks after transplant and 32.9 (29.1-38.0) kPa in the subsequent 4-8 weeks after OLT (P < 0.0001). As expected, liver stiffness measurements reduced from 39.3 (24.9-75.0) kPa to 8.6 (6.8-11.8) kPa in patients receiving OLT (P = 0.0004).
  
  
  CONCLUSIONS
  Spleen stiffness can non-invasively assess changes in portal pressure after liver transplantation and decreases significantly when portal hypertension resolves.
authors: Liver Unit, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland.
authors: Jun Liong
authors: JL
authors: Chin
authors: Grace
authors: G
authors: Chan
authors: John D
authors: JD
authors: Ryan
authors: P Aiden
authors: PA
authors: McCormick
mesh_terms: D054459:Elasticity Imaging Techniques; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D007494:Ireland; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D011446:Prospective Studies; D013154:Spleen / Q000000981:diagnostic imaging*; D018709:Statistics, Nonparametric
keywords: liver transplantation; portal hypertension; spleen stiffness; transient elastography