title: Splenectomy is not indicated in living donor liver transplantation.
abstract: Simultaneous splenectomy (SPX) is preferentially performed in living donor liver transplantation (LDLT) to modulate portal flow; increase postoperative platelet count, especially among those with hepatitis C virus (HCV) infection; and modulate the immunologic status in ABO-incompatible cases. The negative effects of the procedure, however, are not well established. Records of 395 LDLTs performed at our institution, including 169 (42.8%) patients with simultaneous SPX and 226 (57.2%) patients with spleen preservation, were reviewed with special reference to the simultaneous SPX cases. The most common indication for SPX was HCV-related disease (n = 114), followed by low preoperative platelet count (n = 52), and other reasons (n = 3). Simultaneous splenectomy did not increase the platelet count in the early postoperative period, but the incidence of reoperation for postoperative hemorrhage was increased, mainly at the SPX site, within the first week. In addition, the operative time, intraoperative blood loss, and incidence of lethal infectious disease were significantly higher in the SPX group, whereas the incidence of small-for-size syndrome was comparable between groups. Finally, SPX was an independent predictor for both postoperative hemorrhage (odds ratio [OR] = 2.451; 95% confidence interval [CI] = 1.285-4.815; P = 0.006) and lethal infectious complication (OR = 3.748; 95% CI = 1.148-14.001; P = 0.03). In conclusion, on the basis of the present findings, we do not recommend simultaneous SPX in LDLT. Liver Transplantation 22 1526-1535 2016 AASLD.
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Kyoji
authors.initials: K
authors.lastname: Ito
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan. nakamats-tky@umin.ac.jp.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ichida
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ito
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Arita
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006526:Hepatitis C / Q000276:immunology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010976:Platelet Count; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013154:Spleen / Q000276:immunology* / Q000601:surgery; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D013163:Splenomegaly / Q000276:immunology / Q000601:surgery*; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System