title: Splenectomy during whole liver transplantation: a morbid procedure which does not adversely impact long-term survival.
abstract: Indications for splenectomy (SP) during whole liver transplantation (LT) remain controversial and SP is often avoided because of common complications. We aimed to evaluate specific complications of these combined procedures.
  
  
  
  Data were retrospectively analysed. Splenectomy was performed in patients with splenorenal shunt and/or splenic artery aneurysms or hypersplenism. Patients undergoing simultaneous transplantation and splenectomy (LTSP group) were matched to a non-splenectomy group (LT group).
  
  
  
  Between 1994 and 2013, we included 47 and 94 patients in LTSP and LT groups, respectively. The LTSP patients had a higher rate of pre-LT portal vein thrombosis (PVT). The LTSP group had a longer operative time and greater blood loss. Mean follow-up was 101 months and 5-year survivals were identical (LTSP 85% vs LT 88%, p = 0.831). Hospital morbidity and rejection incidence were comparable, whereas de novo PVT (34% vs 2%, p < 0.0001) and infection (47% vs 25%, p = 0.014) rates were higher after SP.
  
  
  
  Splenectomy during LT is technically demanding and exposes recipients to a higher thrombosis rate, therefore portal vein patency must be specifically assessed postoperatively. In selected recipients, SP can be performed without increased mortality but at the price of worsening outcome as evidenced by greater risk of infection and PVT.
authors.affiliation: Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France. Electronic address: nicolasgolse@me.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Golse
authors.affiliation: Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France. Electronic address: kayvan.mohkam@chu-lyon.fr.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Mohkam
authors.affiliation: Croix-Rousse Hospital, Radiology Department, Hospices Civils de Lyon, Lyon, France. Electronic address: agnes.rode@chu-lyon.fr.
authors.forename: Agnès
authors.initials: A
authors.lastname: Rode
authors.affiliation: Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, CRCL, Lyon, France; Centre for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France. Electronic address: pradat@univ-lyon1.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pradat
authors.affiliation: Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France. Electronic address: christian.ducerf@chu-lyon.fr.
authors.forename: Christian
authors.initials: C
authors.lastname: Ducerf
authors.affiliation: Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France. Electronic address: jean-yves.mabrut@chu-lyon.fr.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000209:etiology; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D011169:Portal Vein; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology