Is simultaneous partial splenectomy during pediatric liver transplantation safe and effective for severe hypersplenism? A prospective cohort study. (April 2021)

• Record Type: Journal Article
• Authors: Wei, Lin; Zhou, Guang-Peng; Qu, Wei; Zeng, Zhi-Gui; Sun, Li-Ying; Liu, Ying; Tan, Yu-Le; Wang, Jun; Zhu, Zhi-Jun
• Is Part Of: International journal of surgery. Volume 88(2021)
• Publication Date: 2021-04
• Subjects: Partial splenectomy -- Liver transplantation -- Hypersplenism -- Thrombocytopenia -- Leukopenia; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2021.105926
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Simultaneous splenectomy during liver transplantation is indicated for patients with cirrhosis complicated by severe hypersplenism, but disastrous procedure-related complications remain a special concern. Simultaneous partial splenectomy was adopted in pediatric liver transplant recipients with severe hypersplenism-related pancytopenia at our institution. Methods: A prospective, single-center analysis of 21 pediatric patients diagnosed with cirrhosis and severe hypersplenism, who underwent liver transplantation between January 2015 to December 2019, was conducted. Patient characteristics, intraoperative parameters, and postoperative outcomes were compared between patients with simultaneous partial splenectomy (n = 13) and those without (n = 8). Results: Simultaneous partial splenectomy significantly increased platelet and leukocyte counts in the early postoperative period, without increasing operative time, intraoperative blood loss and postoperative hospital stay ( P = 0.64, P = 0.44, P = 0.26, respectively). No significant differences were observed between the two groups regarding the incidence of postoperative hemorrhage ( P = 0.38), pneumonia ( P = 0.33), cholangitis ( P = 0.38), thrombotic complications ( P = 1.00), cytomegalovirus infection ( P = 0.53), Epstein-Barr virus infection ( P = 0.20) and acute rejection ( P = 0.26). Conclusion: Simultaneous partial splenectomy during liver transplantation could serve as a feasible alternative to splenectomy in selected patients with severe hypersplenism, which can achieve a satisfactory long-term hematological response, but avoid untoward complications of splenectomy. Highlights: This is the first successful series of simultaneous partial splenectomy during liver transplantation for hypersplenism. Simultaneous partial splenectomy can achieve a satisfactory hematological response but avoid untoward complications. Simultaneous partial splenectomy can be a viable alternative to splenectomy for patients with severe hypersplenism.