title: The role of splenectomy before liver transplantation in biliary atresia patients.
abstract: OBJECTIVE
  There is currently no unified view regarding whether liver transplantation or splenectomy should be performed for hypersplenism before liver transplantation in biliary atresia (BA) patients. We herein describe the efficacy of splenectomy before liver transplantation.
  
  
  METHODS
  Splenectomy was performed in ten patients with hypersplenism associated with BA. We retrospectively reviewed their perioperative and postoperative courses, the number of leukocytes and thrombocytes, and the MELD score.
  
  
  RESULTS
  The mean age was 17.5±7.0years (range 11-31years), and the male-to-female ratio was 1:1. The platelet and leukocyte levels increased after splenectomy and returned to normal levels one month postoperatively. The mean MELD score after splenectomy was significantly decreased after splenectomy: 10±2.1 vs 7.6±1.8. In particular, PT-INR improved. Five patients underwent liver transplantation because of hepatopulmonary syndrome and repeated bouts of cholangitis, whereas the remaining five patients did not undergo liver transplantation because of improvements in the liver function (the mean follow-up period was 56months). The postoperative complications included portal vein thrombosis and intestinal perforation, but the patient survival rates remained at 100%.
  
  
  CONCLUSIONS
  After splenectomy, both pancytopenia and the liver function clearly improved. Splenectomy should therefore be a treatment option for patients with hypersplenism before liver transplantation.
  
  
  METHODS
  Retrospective Comparative Study - Level III.
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. Electronic address: yoshiaki@med.kyushu-u.ac.jp.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. Electronic address: matsuura@pedsurg.med.kyushu-u.ac.jp.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Matsuura
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yanagi
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yoshimaru
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D001656:Biliary Atresia / Q000150:complications / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Biliary atresia; Liver transplantation; Splenectomy