Abstract: Objective:To investigate the influence of preoperative splenectomy on the prognosis after liver transplantation.
Methods:The retrospective cohort study was conducted. The clinical data of 95 patients who underwent liver transplantation in the Third Affiliated Hospital of Sun Yatsen University between January 2004 and January 2014 were collected. Thirtyfive patients undergoing preoperative splenectomy and pericardial devascularization and 60 undergoing spleenpreserving liver transplantation were allocated into the study group and control group, respectively. All patients received modified piggyback liver transplantation by the same team. Observation indicators: (1) intra and postoperative situations; (2) followup and survival. The followup using telephone interview and outpatient examination was performed once every a week within 3 months postoperatively, once every one month within 6 months postoperatively and once every 3 months after 1 year postoperatively up to January 2016, including routine blood test, plasmadrug concentration of immunosuppressive agent and function of liver and kidney. Ultrasound and abdominal CT were used to monitor the longterm complication and survival. The measurement data with normal distribution were represented as ±s, and comparison between groups was done by the t test. Comparison of count data was done by the chisquare test.
Results:(1) Intra and postoperative situations: all patients underwent successful liver transplantation. The operation time, volumes of intraoperative blood loss and blood transfusion were (483 ± 136) minutes, (5 683±2 950)mL, (4 887±3 682)mL in the study group and (392±103)minutes, (3 522±1 885)mL, (3 455±2 630)mL in the control group, respectively, with statistically significant differences between groups (t=3.683, 4.358, 2.202, P<0.05). Six patients in the study group had intraoperative portal vein thrombosis (PVT), including 4 in level 1, 1 in level 2 and 1 in level 3, and no patients in the control group, showing a statistically significant difference between groups (x²=1.979, P<0.05). Five patients with PVT in level 1 or 2 underwent thrombectomy and then endtoend anastomosis of PV. One patient with PVT in level 1 had PVT recurrence and was cured by postoperative thrombolytic therapy. One patient with PVT in level 3 received PV reconstruction using artificial blood vessels, and had PVT recurrence and then was cured. There was no PV stenosis between groups. The levels of platelet at 1, 3 and 7 days postoperatively were (75±60)×10⁹/L, (71± 45)×10⁹/L, (111±73)×10⁹/L in the study group and (57±32)×10⁹/L, (52±46)×10⁹/L, (87±53)×10⁹/L in the control group, respectively, with statistically significant difference between groups (t=1.909, 1.957, 1.848, P<0.05). The levels of platelet at 14 and 30 days postoperatively were respectively (230± 152)×10⁹/L, (310±140)×10⁹/L in the study group and (193±125)×10⁹/L, (286±62)×10⁹/L in the control group, with no statistically significant difference between groups (t=1.284, 1.199, P>0.05). The cases with postoperative infection, acute rejection, newonset PVT in level 1-2 and 3-4 and PV stenosis were respectively 23, 0, 2, 0, 2 in the study group and 35, 1, 2, 0, 1 in the control group, with no statistically significant difference between groups (x²=1.171, 0.590, 0.547, 1.184, P>0.05). Patients with postoperative infection and acute rejection were improved by symptomatic treatment. Two patients in the study group with PVT underwent anticoagulant and thrombolytic therapy, including 1 receiving interventional thrombectomy therapy. Two patients in the control group with newonset PVT were cured by anticoagulant and thrombolytic therapy. Three patients with PV stenosis underwent percutaneous transhepatic portography (PTA) for balloon dilation, including 1 in the study group with good improvement after stent implantation. (2) Followup and survival: 95 patients were followed up for 3-24 months, with an average time of 18 months. During the followup, the rate of chronic rejection in study and control groups was 5.7%(2/35) and 5.0%(3/60), showing no statistically significant difference between groups (x²=0.023, P>0.05). The 1 and 2year accumulative survival rates were respectively 91.4%(32/35), 82.9%(29/35) in the study group and 93.3%(56/60), 76.7%(46/60) in the control group, with no statistically significant difference between groups (x²=0.780, P>0.05).
Conclusion:The splenectomy before liver transplantation is easy to form PVT, increase time and difficulty of transplantation surgery, however, it doesn′t increase complication risk after transplantation and affect postoperative survival.