The improvement of preoperative hypersplenism in patients with end-stage liver diseases following liver transplantation

Abstract

Abstract: Objective To explore the improvement of preoperative hypersplenism in patients with end-stage liver diseases (ESLD) following liver transplantation. Methods The data of 156 ESLD patients who underwent liver transplantation from March 2015 to March 2019 were investigated. All patients were classified into a severe splenomegaly group (N=65) and a splenomegaly group (N=91) based on whether their spleen diameter ≥170 mm or <170 mm. The improvement of preoperative hypersplenism was compared between these two groups. Results The white blood cell counts were 3.30×10⁹/L and 4.63×10⁹/L (P<0.001), platelet counts were 107.6×10⁹/L and 149.0×10⁹/L (P<0.001), spleen diameters were 150.0 mm and 125.5 mm (P<0.001), and portal hyper-perfusion were 1647 mL/min and 1300 mL/min (P=0.001) in patients with severe splenomegaly and splenomegaly, respectively, after one year post liver transplantation. There were significant differences between the two groups. Conclusion Patients with severe splenomegaly had lower white blood cell and platelet counts and more severe portal hyper-perfusion compared to those patients with splenomegaly.

Key words: Liver transplantation, Portal hyper perfusion, Splenomegaly, White blood cell, Platelet

XIANG Lu, LI Jing, ZHANG Da-li, LIU Jia, ZHANG Xiao-feng. The improvement of preoperative hypersplenism in patients with end-stage liver diseases following liver transplantation[J]. Chinese Hepatolgy, 2025, 30(2): 180-182.

References

[1] Tonon M, D'Ambrosio R, Calvino V, et al. A new clinical and prognostic characterization of the patterns of decompensation of cirrhosis [J]. J Hepatol, 2024,80(4):603-609.
[2] 张达利,周霞,冯丹妮, 等.不同肝移植标准下原发性肝癌患者的预后分析[J].肝脏,2020,25(9):918-915.
[3] Shimata K, Yoon YI, Hibi T, et al. A novel scoring system to predict short-term mortality after living donor liver transplantation for acute liver failure [J]. Am J Transplant, 2024, 29(4):S1600-6135(24)00288-0.
[4] Karlsen TH, Rutter H, Carrieri P, et al. The EASL-Lancet Commission on liver health in Europe: prevention, case-finding, and early diagnosis to reduce liver-related mortality [J]. Lancet, 2024,403(4):1522-1524.
[5] Attia A, Rowe IA, Harrison EM, et al. Implausible algorithm output in UK liver transplantation allocation scheme: importance of transparency [J]. Lancet, 2023,401(3):911-912.
[6] Musto JA, Palmer G, Nemer M, et al. Early liver transplant for alcohol-associated liver disease has excellent survival but higher rates of harmful alcohol use [J]. Clin Gastroenterol Hepatol, 2024, 22(8):S1542-3565(24)00432-4.
[7] Ullah K, Dogar AW, Shams Ud D, et al. Splenic artery transposition for hepatic arterial supply in living donor liver transplantation [J]. Pak J Med Sci, 2023,39(1):154-160.
[8] Wilder IW, Reskallah A, Pivalizza CM, et al. Refractory thrombocytopenia during liver transplantation requiring splenectomy [J]. Proc (Bayl Univ Med Cent), 2023,36(1):96-98.
[9] Kohler A, Moller PW, Frey S, et al. Portal hyperperfusion after major liver resection and associated sinusoidal damage is a therapeutic target to protect the remnant liver [J]. Am J Physiol Gastrointest Liver Physiol, 2019,317(3):G264-G274.
[10] Dili A, Bertrand C, Lebrun V, et al. Hypoxia protects the liver from Small For Size Syndrome: A lesson learned from the associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure in rats [J]. Am J Transplant, 2019,19(11):2979-2990.
[11] Presser N, Quintini C, Tom C, et al. Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients: a 5-year experience [J]. Liver Transpl, 2015,21(4):435-41.
[12] De Rudder M, Manco R, Coubeau L, et al. Vascular damage and excessive proliferation compromise liver function after extended hepatectomy in mice [J]. Hepatology, 2024, 25(4).
[13] Kirchner VA, Shankar S, Victor DW, 3rd, et al. Management of established small-for-size syndrome in post living donor liver transplantation: medical, radiological, and surgical interventions: guidelines from the ILTS-iLDLT-LTSI Consensus Conference [J]. Transplantation, 2023,107(10):2238-2246.
[14] Matsushima H, Soyama A, Hara T, et al. Outcomes of living donor liver transplant recipients receiving grafts with the graft-to-recipient weight ratio less than 0.6%: a matched pair analysis [J]. Liver Transpl, 2024,30(5):519-529.
[15] Kow AWC, Liu J, Patel MS, et al. Post living donor liver transplantation small-for-size syndrome: definitions, timelines, biochemical, and clinical factors for diagnosis: guidelines from the ILTS-iLDLT-LTSI Consensus Conference [J]. Transplantation, 2023,107(10):2226-2237.
[16] Neumann UP, Berg T, Bahra M, et al. Fibrosis progression after liver transplantation in patients with recurrent hepatitis C [J]. Journal of Hepatology, 2004,41(5):830-836.
[17] Sourianarayanane A, Arikapudi S, McCullough AJ, et al. Nonalcoholic steatohepatitis recurrence and rate of fibrosis progression following liver transplantation [J]. Eur J Gastroenterol Hepatol, 2017,29(4):481-487.
[18] 冯丹妮,张达利,贺希,等.肝移植术后新发非酒精性脂肪肝的危险因素[J].肝脏,2022,27(1):95-97.
[19] 冯丹妮,张达利,贺希, 等.酒精性肝硬化的肝移植受者血小板减少的病例对照研究[J].肝脏,2022,27(5):540-542.
[20] Lecchi A, Tosetti G, Ghali C, et al. Comprehensive investigation of platelet function in patients with cirrhosis [J]. Thromb Res, 2024,237(5):64-70.
[21] Patrono D, Franchi E, Guarasci F, et al. Vascular remodeling of visceral arteries following interruption of the splenic artery during liver transplantation [J]. Liver Transpl, 2019,25(6):934-945.