title: Optimal changes in portal hemodynamics induced by splenectomy during living donor liver transplantation.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of splenectomy in adult-to-adult living donor liver transplantation (LDLT).
  
  
  METHODS
  Adult-to-adult LDLTs (n = 276) were divided into those with simultaneous splenectomy during LDLT (Splenectomy group, n = 154) and those without (Non-Splenectomy group, n = 122).
  
  
  RESULTS
  In the Splenectomy group, splenectomy decreased the portal venous pressure from 24.0 to 19.1 mmHg (p < 0.001). At the end of surgery, the portal venous pressure was significantly lower and the graft compliance was significantly higher in the Splenectomy group compared with the Non-Splenectomy group. The graft portal venous flow was also better in the Splenectomy group (y = 625-5.1x; r (2) = 0.08, p < 0.01) than in the Non-Splenectomy group (y = 470-2.9x; r (2) = 0.04, p = 0.03). Fourteen days after LDLT, the total bilirubin and ascites output were lower in the Splenectomy group than in the Non-Splenectomy group. Among the patients with hepatitis C, splenectomy was associated with a significantly higher rate of a sustained viral response (59.4 vs. 35.9%, p = 0.020) than was noted in those without splenectomy (n = 39). There were no patients with post-splenectomy sepsis under vaccination.
  
  
  CONCLUSIONS
  By decreasing the portal pressure and increasing the graft vascular compliance, splenectomy conferred better graft outcomes in adult-to-adult LDLT.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
authors: Huanlin
authors: H
authors: Wang
authors: Toru
authors: T
authors: Ikegami
authors: Noboru
authors: N
authors: Harada
authors: Tomoharu
authors: T
authors: Yoshizumi
authors: Yuji
authors: Y
authors: Soejima
authors: Hideaki
authors: H
authors: Uchiyama
authors: Yo-Ichi
authors: Y
authors: Yamashita
authors: Shinji
authors: S
authors: Itoh
authors: Norifumi
authors: N
authors: Harimoto
authors: Hirofumi
authors: H
authors: Kawanaka
authors: Ken
authors: K
authors: Shirabe
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology*; D011169:Portal Vein / Q000502:physiology*; D011379:Prognosis; D013156:Splenectomy