2:10 PM Abstract No. 155 - Predictive factors for improving thrombocytopenia and risk factors for complications after partial splenic embolization in live cirrhosis patients

Abstract

Purpose To investigate the predictive factors for platelet increase and severe complications after partial splenic embolization (PSE) in cirrhosis patients. Materials and Methods Between January 2008 and December 2011, 70 patients with thrombocytopenia and hypersplenism caused by liver cirrhosis were treated with PSE. Among the 70 patients, 42 who had a laboratory studies and computed tomography (CT) follow-up more than 6 months were included in this study. Based on CT images, the pre-PSE splenic volume and the non-infracted splenic volume were measured, then the infarcted splenic volume and the splenic infarction rate were calculated. Various factors for platelet increase and complications after PSE were analysed. Results The mean splenic infarction rate of the 42 patients was 61.9%. In correlation analysis, the splenic infarction rate showed a positive correlation with the increase in platelet counts both at 6 months and 1 year after PSE, whereas the non-infarcted splenic volume showed a negative correlation with the increase in platelet counts. In receiver operating characteristic analysis, the suitable cut-off value of splenic infarction rate for achieving an increase of (60.0-80.0) ×10^9/L in platelet counts both at six months and one year after PSE was 64.3%, while the suitable cut-off value of non-infracted splenic volume was 211.5 ml. After PSE, 7 patients had complications, including pneumonia, massive ascites and pleural effusion, abdominal abscess, encephalopathy, and portal vein thrombosis. The infarcted splenic volume (≥513.1 mL), splenic infarction rate (≥63.4%) and Child-Pugh score (≥10) were identified as the risk factors for complications after PSE. Conclusion The splenic infarction rate and the non-infarcted splenic volume significantly affects the prolonged increase in platelet counts after PSE. A large infarcted splenic volume, a high splenic infarction rate and a severe hepatic dysfunction are the risk factors for severe complications following PSE. In patients with a large pretreatment splenic volume or Child-Pugh class C disease, a partitioned and repeated PSE might be a safer option to gain a sufficient improvement of thrombocytopenia and hypersplenism.