Effects of splenectomy on patients undergoing liver transplantation

Abstract

To investigate the effects of splenectomy before or simultaneously in liver transplantation on the outcome of liver transplantation. Splenectomy was performed on 29 of the consecutive 403 patients undergoing orthotopic liver transplantation (OLT) between February 1999 and May 2005, before the OTC in 23 of which and simultaneously during the OTC in 6 of which. Fifty-eight randomized selected age-matched patients undergoing OTC within the same period but without splenectomy were used as controls. The operation time, bleeding amount, transfusion amount, infection, acute rejection, survival rate, and post-operative recovery of platelet were compared between these groups. The average operation times of the pre-operatively splenectomized group (Group A) and intra-operatively splenectomized group (Group B) were 448.70 +/- 100.51 minutes and 526.67 +/- 99.93 minutes respectively, both significantly longer than that of the non-splenectomized group (Group C) (362.80 +/- 71.65 minutes, both P < 0.001). The intra-operative bleeding amount of the 2 splenectomized groups were both longer than that of the control group, however, not significantly. The intra-operative transfusion amounts of Group B was 3983 +/- 1885 ml, significantly more than that of Group C (2361 +/- 1246 ml, P < 0.05). The plasma transfusion amount of Group B was 8387 +/- 4231 ml, significantly more than that of Group C (4906 +/- 3108 ml, P < 0.05). The concentrated erythrocyte transfusion amount of Group A was 14.2 +/- 14.6 U, significantly more than that of Group C (5.1 +/- 6.6 U, P < 0.001). The bacterial infection rates of the Groups A and B were 91.3% and 100% respectively, both significantly higher than that of Group C (69.0%, both P < 0.05). The mycotic infection rates of the 2 splenectomized groups were 13% and 33.33% respectively, both significantly higher than that of Group C (29.3%), however, both not significantly. Acute rejection rate did not occurred in the 2 splenectomized groups, and in 4 cases of the non-splenectomized group, however, without significant differences among them. The post-operative bleeding rate of Group B was significantly higher than that of Group C (P < 0.05). The accumulative survival of Group C was significantly higher than that of Group B (P = 0.0001). The platelet counts 14 and 20 days after operation of the 2 splenectomized groups were all significantly higher than those of the non-splenectomized group (all P < 0.05), and were higher than the normal levels in some cases. Splenectomy does not benefit the patients undergoing liver transplantation whenever it is performed before or simultaneously in the liver transplantation.