Small-for-size graft (SFSG) syndrome is a main causes of graft loss in living donor liver transplantation (LDLT). Splenectomy (Spx) is an option to prevent this catastrophic complication, but its effect remains controversial. To date, there has been no prospective randomized study to clarify the impact of Spx. The aim of this study was to compare graft function and long-term outcomes of Spx with no portal flow modulation during LDLT between two matched groups.
Three hundred and twenty patients were divided into two groups: with Spx (n=258) and without Spx (n=62). To overcome selection bias, one-to-one matching using propensity score matching (PSM) was performed (n=50, in each group).
Recipients with simultaneous Spx showed better graft function on post-operative-day (POD) 7, 14 and lower sepsis frequency within 6 months after LDLT, and better graft survival rates compared with those without Spx before matching. After PSM, recipients with simultaneous Spx showed lower early graft dysfunction frequency on POD 7 (p=0.04), lower SFSG syndrome frequency (p=0.01), lower serum total bilirubin levels (p=0.001), and lower international normalized ratio (p=0.004) on POD 14, lower sepsis (p=0.02) frequency within 6 months after LDLT, and better graft survival rates (p=0.04) compared with those without Spx. Univariate analysis revealed that without Spx (hazard ratio=3.06, 95% confidence intervals:1.07 – 11.0, p=0.037) was the only risk factor for graft loss after LDLT.
Simultaneous Spx may prevent SFSG syndrome and is a predictive factor for graft survival after LDLT. Simultaneous Spx is recommended when a small graft (GW/SLW 35% or less) is predicted preoperatively, or for patients with portal hypertension or high portal pressure (above 20 mmHg) after reperfusion in LDLT.
Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.