S2577 Management of Splenic Artery Steal Syndrome Following Liver Transplantation by Splenic Artery Embolization

Abstract

INTRODUCTION: The following case series analyzes patients that received a splenic artery embolization (SAE) following an orthotopic liver transplant (OLT). SAE following OLT is performed to correct splenic artery steal syndrome (SASS), where the splenic artery experiences an increase in blood flow at the expense of the hepatic artery. Normal hepatic artery blood flow is needed to ensure a successful transplant. CASE DESCRIPTION/METHODS: Four patients presented for OLT; three with living donors and one standard donor. The indications for OLT were alcoholic cirrhosis, cryptogenic cirrhosis with pancytopenia, NASH, and primary sclerosing cholangitis. The average MELD scores were 18 [11-26]. Two patients had previous history of CT diagnosed thrombosis in the right hepatic and portal veins. One patient had an intraoperative portal vein thrombectomy. Three patients had good size matched anastomotic connections for the hepatic arteries, while one patient’s recipient arteries were smaller than the donors. Upon post-transplant ultrasound, each patient had an increased hepatic artery resistivity index (RI) in the proximal, middle and distal parts of the artery. This indicates decreased blood flow to the liver as part of SASS. The relevant laboratory values immediately preceding SAE showed an average AST of 171.5 [45-301], ALT of 378.25 [249-458], alkaline phosphate of 176.75 [46-368], total bilirubin of 3.9 [1.9-6.6], direct bilirubin of 2.6 [1.4-4.4], and creatinine of 0.9 [0.73-1.05]. To correct this, all patients received an SAE on average 96.5 hours [20-213] following OLT to re-establish adequate blood flow to the liver. This is confirmed through a follow up ultrasound, which reveals decreased hepatic artery RI in all patients. The patient with primary sclerosing cholangitis received a re-do hepatojujenoctomy, however the other three patients did not have any strictures based on MRCP. None of the patients had graft rejection and are currently 6 months to 1 year post-transplant. DISCUSSION: SAE following OLT serves as a viable option for treating SASS. This procedure re-stored proper blood flow through the hepatic artery to the transplanted liver, which prevents graft rejection.