Preoperative Splenomegaly Is a Risk Factor for Prolonged Splenomegaly after Liver Transplantation and Can Result in Hypersplenism and Graft Fibrosis

Abstract

Background: Splenomegaly (SM) often persists after liver transplantation (LT), however, its predictors and clinical significance are unknown. Methods: We analyzed 415 LT recipients in our institution to clarify this issue. First, predictors and clinical consequences of persistent SM three years after LT were analyzed among spleen-preserved recipients. Second, the clinical data of surviving recipients three years after LT were compared between splenectomized and spleen-preserved recipients using propensity score matching (PSM). Third, survival outcomes were compared between splenectomized and spleen-preserved recipients after PSM. SM was determined as a splenic volume (SV)/body surface area (BSA) > 152 ml/m2 based on the CT splenic volumetry data of 140 donors. Results: In the first analysis, among 119 recipients with preoperative SM, 86 (73.6%) recipients had persistent SM 3 years after LT. Preoperative SV/BSA was the only independent predictor for the persistent SM and it was associated with lower platelet (PLT) and white blood cell (WBC) counts and significant graft fibrosis (≥ Metavir F2) (21.4% vs. 2.8%, p = 0.01). In the second analysis, spleen preservation was related to lower PLT and WBC counts and a higher proportion of significant graft fibrosis (26.7% vs. 7.1%, p = 0.022) three years after LT. In the third analysis, spleen-preserved recipients showed worse survival than splenectomized recipients (73.3% vs. 84.5% at 3 years after LT, p = 0.04). Conclusions: Preoperative SM frequently persists more than three years after LT and is associated with subclinical hypersplenism, graft fibrosis and even death.