title: [The risk factors of splenic arterial steal syndrome after orthotopic liver transplantation].
abstract: OBJECTIVE
  To discuss the risk factors of splenic arterial steal syndrome (SASS) after orthotopic liver transplantation.
  
  
  METHODS
  Twenty-four cases who confirmed SASS after liver transplantation in Tianjin First Central Hospital between June 2005 and June 2013 were analyzed retrospectively. Another 96 cases were selected randomly from those patients of the same time with no complication of SASS patients postoperatively as control group. Clinical data of two groups including diameter of splenic artery and hepatic artery preoperatively, weight of graft, weight of recipients, cold/warm ischemia time, an hepatic period and operation time and so on were collected. Others including hepatic artery peak systolic velocity (PSV), end diastolic velocity (EDV), blood flow resistance index and portal vein average velocity (PVF) on the first day after liver transplantation, the day before diagnosis, the day when diagnosed, the 1, 3, 7 days after treatment in SASS group and on 1, 3, 7, 9, 11, 14 days after liver transplantation in control group. Statistical analysis were made between two groups.
  
  
  RESULTS
  The splenic artery/hepatic artery ratio preoperatively and weight of donor liver,and the GRWR in SASS group and control group were 1.26 and 1.00, 1 032 g and 1 075 g, (1.40±0.30)% and (1.82±0.21)% respectively, with significantly statistical differences (Z=-6.40, Z=-2.22, t=-6.50; all P<0.05). The warm ischemia time, the cold ischemia time, the anhepatic period and operation time in SASS group and control group were 3.5 minutes and 4.0 minutes, 10.25 hours and 10.10 hours, 43 minutes and 45 minutes, 8.7 hours and 8.7 hours, with no significantly statistical differences (all P>0.05). RI of hepatic went up gradually in the early time after transplantation while dropped obviously when spleen artery spring coils embolization was received (P<0.01) and trended to stable two weeks later.
  
  
  CONCLUSIONS
  Splenic artery/hepatic artery ratio and GRWR are the positive and negative risk factors respectively for SASS. The gradual rising of hepatic RI in the early time after transplantation may be the warning signal SASS and spleen artery spring coils embolization is the effective strategy for SASS after liver transplantation.
authors.affiliation: First Central Clinic Institute of Tianjin Medical University, Tianjin 300192, China.
authors.forename: Luzhou
authors.initials: L
authors.lastname: Zhang
authors.forename: Dahong
authors.initials: D
authors.lastname: Teng
authors.forename: Guang
authors.initials: G
authors.lastname: Chen
authors.forename: Zhenglu
authors.initials: Z
authors.lastname: Wang
authors.forename: Ying
authors.initials: Y
authors.lastname: Tang
authors.forename: Haijun
authors.initials: H
authors.lastname: Gao
authors.affiliation: Email: zhenghongxy@163.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Zheng
mesh_terms: D050377:Cold Ischemia; D004621:Embolization, Therapeutic; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000098:blood supply*; D013157:Splenic Artery / Q000473:pathology*; D014652:Vascular Diseases / Q000453:epidemiology*; D052096:Warm Ischemia