TY - JOUR
T1 - Simultaneous splenectomy improves outcomes after adult living donor liver transplantation
AU - Yoshizumi, Tomoharu
AU - Itoh, Shinji
AU - Shimokawa, Mototsugu
AU - Inokuchi, Shoichi
AU - Harada, Noboru
AU - takeishi, kazuki
AU - Mano, Yohei
AU - Yoshiya, Shohei
AU - Kurihara, Takeshi
AU - Nagao, Yoshihiro
AU - Ikegami, Toru
AU - Soejima, Yuji
AU - Mori, Masaki
N1 - Funding Information:
This work was partly supported by JSPS KAKEN Grant Number ( 15H0579 and 18K08542 ), and by the Program for Basic and Clinical Research on Hepatitis from the Japan Agency for Medical Research and Development , AMED 18fk0210023h0002 .
Funding Information:
This work was partly supported by JSPS KAKEN Grant Number (18K08542), and by the Program for Basic and Clinical Research on Hepatitis from the Japan Agency for Medical Research and Development, AMED (20fk0210035s0503, 19fk0310106s0203 and 19fm0208009h0003).
Publisher Copyright:
© 2020 European Association for the Study of the Liver
PY - 2021/2
Y1 - 2021/2
N2 - Background & Aims: Small-for-size graft (SFSG) syndrome is a major cause of graft loss after living donor liver transplantation (LDLT). Splenectomy (Spx) is an option to prevent this catastrophic complication, but its effect remains controversial. Herein, we aimed to elucidate the effect of simultaneous Spx on graft function and long-term outcomes after LDLT. Methods: Three hundred and twenty patients were divided into 2 groups: those undergoing (n = 258) and those not undergoing (n = 62) simultaneous Spx. To overcome selection bias, propensity score matching (PSM) was performed (n = 50 in each group). Results: Before PSM, recipients undergoing simultaneous Spx showed better graft function on post-operative day (POD) 7 and 14, as well as lower sepsis frequency within 6 months after LDLT and better graft survival rates compared to those not undergoing Spx. After PSM, compared to patients not undergoing Spx, those undergoing Spx had a lower frequency of early graft dysfunction on POD 7 (p = 0.04); a lower frequency of SFSG syndrome (p = 0.01), lower serum total bilirubin levels (p = 0.001), and lower international normalized ratio (p = 0.004) on POD 14; lower sepsis frequency within 6 months after LDLT (p = 0.02), and better graft survival rates (p = 0.04). Univariate analysis revealed that not undergoing Spx (hazard ratio 3.06; 95% CI 1.07–11.0; p = 0.037) was the only risk factor for graft loss after LDLT. Conclusions: 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. Lay summary: Living donor liver transplantation (LDLT) for patients with acute or chronic liver failure is an alternative to overcome the deceased donor shortage. The potential mismatch between graft and body size is a problem that needs to be solved for LDLT recipients. Herein, we evaluated the impact of simultaneous splenectomy and showed that it was associated with favorable outcomes in patients undergoing LDLT.
AB - Background & Aims: Small-for-size graft (SFSG) syndrome is a major cause of graft loss after living donor liver transplantation (LDLT). Splenectomy (Spx) is an option to prevent this catastrophic complication, but its effect remains controversial. Herein, we aimed to elucidate the effect of simultaneous Spx on graft function and long-term outcomes after LDLT. Methods: Three hundred and twenty patients were divided into 2 groups: those undergoing (n = 258) and those not undergoing (n = 62) simultaneous Spx. To overcome selection bias, propensity score matching (PSM) was performed (n = 50 in each group). Results: Before PSM, recipients undergoing simultaneous Spx showed better graft function on post-operative day (POD) 7 and 14, as well as lower sepsis frequency within 6 months after LDLT and better graft survival rates compared to those not undergoing Spx. After PSM, compared to patients not undergoing Spx, those undergoing Spx had a lower frequency of early graft dysfunction on POD 7 (p = 0.04); a lower frequency of SFSG syndrome (p = 0.01), lower serum total bilirubin levels (p = 0.001), and lower international normalized ratio (p = 0.004) on POD 14; lower sepsis frequency within 6 months after LDLT (p = 0.02), and better graft survival rates (p = 0.04). Univariate analysis revealed that not undergoing Spx (hazard ratio 3.06; 95% CI 1.07–11.0; p = 0.037) was the only risk factor for graft loss after LDLT. Conclusions: 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. Lay summary: Living donor liver transplantation (LDLT) for patients with acute or chronic liver failure is an alternative to overcome the deceased donor shortage. The potential mismatch between graft and body size is a problem that needs to be solved for LDLT recipients. Herein, we evaluated the impact of simultaneous splenectomy and showed that it was associated with favorable outcomes in patients undergoing LDLT.
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U2 - 10.1016/j.jhep.2020.08.017
DO - 10.1016/j.jhep.2020.08.017
M3 - Article
C2 - 32827564
AN - SCOPUS:85096837725
SN - 0168-8278
VL - 74
SP - 372
EP - 379
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 2
ER -