title: Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients: a 5-year experience.
abstract: Severe portal hyperperfusion (PHP) after liver transplantation has been shown to cause intrahepatic arterial vasoconstriction secondary to increased adenosine washout (hepatic artery buffer response). Clinically, posttransplant PHP can cause severe cases of refractory ascites and hydrothorax. In the past, we reported our preliminary experience with the use of splenic artery embolization (SAE) as a way to reduce PHP. Here we present our 5-year experience with SAE in orthotopic liver transplantation (OLT). Between January 2007 and December 2011, 681 patients underwent OLT at our institution, and 54 of these patients underwent SAE for increased hepatic arterial resistance and PHP (n=42) or refractory ascites/hepatic hydrothorax (n=12). Patients undergoing SAE were compared to a control group matched by year of embolization, calculated Model for End-Stage Liver Disease score, and liver weight. SAE resulted in improvements in hepatic artery resistive indices (0.92±0.14 and 0.76±0.10 before and after SAE, respectively; P<0.001) and improved hepatic arterial blood flow (HAF; 15.6±9.69 and 28.7±14.83, respectively; P<0.001). Calculated splenic volumes and spleen/liver volume ratios were correlated with patients requiring SAE versus matched controls (P=0.002 and P=0.001, respectively). Among the 54 patients undergoing SAE, there was 1 case of postsplenectomy syndrome. No abscesses, significant infections, or bleeding was noted. We thus conclude that SAE is a safe and effective technique able to improve HAF parameters in patients with elevated portal venous flow and its sequelae.
authors.affiliation: Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Naftali
authors.initials: N
authors.lastname: Presser
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Cynthia
authors.initials: C
authors.lastname: Tom
authors.forename: Weiping
authors.initials: W
authors.lastname: Wang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.forename: Teresa
authors.initials: T
authors.lastname: Diago-Uso
authors.forename: Masato
authors.initials: M
authors.lastname: Fujiki
authors.forename: Charles
authors.initials: C
authors.lastname: Winans
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
mesh_terms: D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D009820:Ohio; D011168:Portal System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011172:Portography; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013157:Splenic Artery / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color