Diagnosis and treatment of splenic artery steal syndrome after orthotopic liver transplantation

Abstract

Objective To study the clinical data of the splenic artery steal syndrome(SASS) after liver transplant surgery.Methods The clinical data of 1020 cases of liver transplantation were retrospectively analyzed,the SASS occurrence in recipients was observed,and the factors influencing SASS incidence,including the recipients' gender,primary disease,thrombocyte level before transplantation,the liver donor conditions,graft to recipient weight ratio(GRWR),etc,were statistically analyzed.The diagnosis of SASS was achieved by a combination of B-ultrasound and digital subtraction angiography(DSA).All patients were subjected to super-selective embolization of the steal artery.A post-operative follow-up of 8～36 months was conducted after the surgery.Results Eleven(1.09%)of the recipients undergoing liver transplantation were diagnosed as SASS,all occurring within one month post-operation,with an average of(13.63±10.93)days.Recipients'gender,primary disease,or thrombocyte level before transplantation showed no statistically significant difference(P＞0.05),while low GRWR indicated a higher incidence of SASS(P＜0.01).After interventional therapy.all 11 recipients displayed good condition,with normal liver blood flow and liver function,and no signs of thrombus and ischemic biliary complication.Only one of the patients developed small pieces of spleen infarction after interventional therapy.Conclusions SASS has no early specific clinical manifestation after transplantation.The monitor of low GRWR recipients is very important.The adoption of B-ultrasound and DSA provides a meads of early detection.After SASS is confirmed,treatment of super-selective embolization of steal artery is recommended. Key words: Liver transplantation; Splenic artery; Diagnosis; Therapy