Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis ‐ a retrospective study. (9th November 2020)

• Record Type: Journal Article
• Authors: Nam, Nguyen Hai; Taura, Kojiro; Yao, Siyuan; Kaido, Toshimi; Uemoto, Yusuke; Kimura, Yusuke; Anazawa, Takayuki; Fukumitsu, Ken; Ito, Takashi; Yagi, Shintaro; Kamo, Naoko; Hata, Koichiro; Uemoto, Shinji
• Is Part Of: Transplant international. Volume 33:Number 12(2020)
• Page Start: 1807
• Page End: 1820
• Publication Date: 2020-11-09
• Subjects: liver transplantation -- splenomegaly -- thrombocytopenia -- liver fibrosis -- splenectomy; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13761
• Languages: English
• ISSNs: 0934-0874

Abstract

Abstract: The risk factors and clinical impact of post‐transplantation splenomegaly (SM) are poorly understood. We investigated the predictors and impacts of post‐transplantation SM in 415 LT patients at Kyoto University Hospital from April 2006 to December 2015. First, the predictors and clinical consequences of SM three years post‐transplantation were analyzed among spleen‐preserved recipients. Second, the clinical data of surviving recipients three years post‐transplantation were compared between splenectomized and spleen‐preserved recipients. There was no difference in indication for liver transplantation between these two groups. Third, survival outcomes were compared between splenectomized and spleen‐preserved recipients. SM was determined as a SV/body surface area (BSA) higher than 152 ml/m 2 . In the first analysis, preoperative SM occurred in 79.9% recipients and SM persisted three years post‐transplantation in 72.6% recipients among them. Preoperative SV/BSA was the only independent predictor of three year post‐transplantation SM, which was associated with lower platelet (PLT), white blood cell (WBC) counts and significant graft fibrosis (21.4% vs. 2.8%). In the second analysis, spleen‐preservation was related to lower PLT, WBC counts and a higher proportion of significant graft fibrosis (26.7% vs. 7.1%) three years post‐transplantation. In the third analysis, spleen‐preserved recipients showed worse survival than splenectomized recipients. In conclusion, preoperative SM frequently persists more than three years post‐transplantation and is associated with subclinical hypersplenism, graft fibrosis, graft loss, and even death.