3:27 PM Abstract No. 159 Endovascular treatment of splenic artery steal in pediatric liver transplant patients

Abstract

Literature regarding splenic artery embolization for splenic artery steal syndrome (SASS) in the pediatric liver transplant population is limited, possibly due to lack of recognition of this entity. The purpose of this study is to evaluate the safety and efficacy of splenic artery embolization in pediatric liver transplant patients with clinical and imaging findings concerning for SASS. A retrospective review was performed on all pediatric liver transplant patients who had undergone splenic artery embolization for suspected SASS at a tertiary pediatric institution between June 2013 and May 2018. Parameters assessed included patient age, time from transplant to splenic artery embolization, transplant type, pre-and-post procedure Doppler ultrasound (DUS) findings, procedural details, complication rate, pre-and-postprocedural laboratory parameters, and clinical efficacy. 5 patients (average age, 8 years; median, 10 years; range, 2-17 years) had proximal to mid splenic artery embolization for suspected SASS. Technical success = 100%. Average time from transplant to embolization was 61.6 days (median = 3 days; range, 2-265). All patients had parvus tardus waveform on pre-embolization DUS. Average pre and post embolization peak hepatic artery systolic velocity = 35.7 cm/s (median, 24 cm/s; range, 15.7-89) and 39.1 cm/s (median, 32 cm/s; range, 26-55), respectively. Average pre and post embolization resistive indices = 0.71 (median, 0.73; range, 0.4-1) and 0.62 (median, 0.6; range, 0.5-0.8), respectively. Average pre and post embolization total bilirubin levels = 1.5 mg/dL (median, 1.3; range, 0.4-3.7) and 1.02 mg/dL (median, 0.9; range, 0.3-2.4), respectively. Average pre and post embolization platelet levels = 72.6 thousand/microL (median, 43; range, 18-181) and 141 thousand/microL (median, 111; range, 49-183). There were no major complications. All patients had morphologically improved hepatic artery upstroke on DUS following splenic artery embolization. Splenic artery embolization for suspected SASS in pediatric liver transplant patients is potentially a safe and effective technique in improving graft function and improving thrombocytopenia.