Simultaneous Splenectomy in Living Donor Liver Transplantation

Small-for-size graft (SFSG) syndrome is a major cause of graft loss after living donor liver transplantation (LDLT). Researchers from the Kyushu University, Fukuoka, Japan have found that simultaneous splenectomy can be used to overcome small-for-size graft syndrome. They also found that simultaneous splenectomy improved clinical outcomes in LDLT recipients after propensity-score matching. The research has been published in the Journal of Hepatology on August 19, 2020.

Since the introduction of adult living donor liver transplantation (LDLT), graft size has become a concern, particularly for patients with chronic liver failure and/or portal hypertension. Small-for-size graft (SFSG) syndrome after LDLT remains a major complication of this procedure. Splenectomy (Spx) is an option to prevent this catastrophic complication, but its effect remains controversial. Therefore, a research team of Japan conducted a study to assess the effect of simultaneous Spx on graft function and long-term outcomes after LDLT.

It was a retrospective analysis of data from 328 patients who underwent primary adult LDLT at Kyushu University Hospital from April 2006 to June 2018. Researchers divided the patients into two following groups: those undergoing (n = 258) and those not undergoing (n = 62) prophylactic splenectomy. They performed propensity score matching (PSM) (n = 50 in each group) to overcome the selection bias and used a logistic regression model to calculate propensity scores for patients.

Key Findings of the Study

• After propensity score matching, the researchers found that compared with participants without splenectomy, those with simultaneous splenectomy had:
  • lower early graft dysfunction frequency on postoperative day 7,
  • lower small-for-size graft syndrome frequency,
  • lower serum total bilirubin levels.
• They also noted that those who underwent simultaneous splenectomy had:
  • lower international normalized ratio on postoperative day 14,
  • lower sepsis frequency within 6 months after living donor liver transplantation, and
  • better graft survival rates.
• Upon univariate analysis, they found that not undergoing Spx (hazard ratio 3.06) was the only risk factor for graft loss after LDLT.

The authors concluded, "Simultaneous Spx may prevent SFSG syndrome and is a predictive factor for graft survival after LDLT. Simultaneous Spx is recommended when a small graft (≤35% of standard liver weight) is predicted preoperatively, or for patients with portal hypertension or high portal pressure (above 20 mmHg) after reperfusion in LDLT."

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