Objective To investigate the clinical value of adult right lobe split liver transplantation combined with partial splenectomy in the treatment of hepatitis B related cirrhosis with severe hypersplenism.

Methods The retrospective and descriptive study was conducted. The clinical data of a 44-year-old male patient with hepatitis B related cirrhosis and severe hypersplenism who was admitted to The First Affiliated Hospital of Harbin Medical University in October 2024 were collected. The patient underwent adult right lobe split liver transplantation combined with partial splenectomy. Observation indicators: (1) surgical conditions; (2) follow-up.

Results (1) Surgical conditions: the patient successfully underwent adult right lobe split liver transplantation combined with partial splenectomy. The total operation time was 570 minutes, vascular reconstruction time was 47 minutes, anhepatic phase was 45 minutes, and partial splenectomy time was 70 minutes.The volume of intraoperative blood loss was approximately 800 mL. The actual graft weight was 766 g, with a graft-to-recipient weight ratio of 0.87% and a ratio of right lobe graft volume to standard liver volume of 41%. After graft reperfusion, the initial portal vein pressure (PVP) was 24 mmHg (1 mmHg=0.133 kPa). Approximately 60% of the superior splenic pole was resected, reducing the PVP to 13 mmHg with stable hemodynamics. Postoperative liver function of the patient recovered uneventfully, with aminotransferases and total bilirubin showing downward trends, while white blood cell and platelet counts increased significantly. Abdominal drainage was highest on postoperative day 1 (1 600 mL), gradually decreased thereafter, and the drainage tube was removed on postoperative day 9 when drainage output was <100 mL. Regular ultrasonography showed no abnormalities in the graft. Three-dimensional reconstruction of computed tomography revealed gradual graft volume increase (1 211 cm³ on postoperative day 6, 1 492 cm³ on postoperative day 15). T-tube cholangiography on postoperative day 14 showed no abnormalities, and the T-tube was clamped on the following day. Low molecular weight heparin anticoagulation was initiated on postoperative day 3. The immunosuppressive regimen consisted of tacrolimus, mycophenolate sodium, and methylprednisolone. The patient was discharged uneventfully on postoperative day 18 without rejection or infectious complications.(2) Follow-up: during the 14-month follow-up, graft function remained stable. Ultrasonography demonstrated normal graft blood flow without thrombosis. Three-dimensional reconstruction of computed tomography showed continuous reduction of splenic volume compared to the early postoperative period (1 376 cm³ on postoperative day 6, 1 042 cm³ on postoperative day 56, and 895 cm³ at 14 month postoperatively). Major liver function indicators, white blood cell and platelet counts remained normal. Peripheral blood immunoglobulin classification and quantification were normal. No infection-related complications occurred during the follow-up period.

Conclusion Adult right lobe split liver transplantation combined with partial splenectomy for hepatitis B related cirrhosis with severe hypersplenism can safely and effectively regulate portal hemodynamics, correct hypersplenism, and offer clinical advantages in terms of immunoprotection and thrombosis prevention.