Successful laparoscopic splenectomy after living-donor liver transplantation for thrombocytopenia caused by antiviral therapy

Increased Risk of Short-Term Infection After Liver Transplantation Combined With Splenectomy: Clinical Retrospective Study

AIM

The safety of liver transplantation and simultaneous splenectomy (LTSP) is still controversial. This study aimed to compare postoperative outcomes and infection in liver transplant recipients with and without simultaneous splenectomy.

METHODS

Clinical data of patients who underwent liver transplantation (LT) from May 2015 to March 2023 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The main parameters measured were culture results, infection incidence, pathogens, postoperative complications, and overall survival rates.

RESULTS

Of 149 patients, 35 who underwent LTSP were assigned to the LTSP group, and the remaining 114 were assigned to the LT group. The postoperative infection incidence in the LTSP group was significantly higher than in the LT group within 1 month after transplantation. The two groups had no significant differences in pathogens details and overall survival rate. SP, postoperative days (POD) 3 Neutrophil to lymphocyte ratio (NLR), POD 7 NLR, and POD 7 Hemoglobin (HGB) were independent risk factors for postoperative infection in multivariate analysis.

CONCLUSION

LTSP increases the risk of short-term postoperative infections, and postoperative NLR can be used as a marker of infection.

Outcomes of Infection and Risk of Mortality in Liver Transplant Patients with Simultaneous Splenectomy

PURPOSE

The purpose of this study was to compare the outcomes of infection between liver transplant patients with and without simultaneous splenectomy.

METHODS

We retrospectively analyzed the records of 211 patients who underwent liver transplantation in the Tri-Service General Hospital from 2012 to 2017. The frequency of blood cultures obtained after liver transplantation; incidence of bacteremia, pathogens, and complications; and overall survival rates were compared between the groups.

RESULTS

One hundred thirty-three of 211 patients underwent liver transplantation without simultaneous splenectomy. There were no significant differences in the frequency of blood cultures obtained after liver transplantation (non-splenectomy group and splenectomy group: 63% and 62%, respectively); incidences of bacteremia after liver transplantation (21% and 21%, respectively), repeat bacteremia (39% and 35%, respectively), cytomegalovirus infection (4% and 3%, respectively), herpes infection (6% and 7%, respectively), and fungal infection (3% and 3%, respectively); and overall survival rate between the two groups. However, there was a significant difference in infection-related deaths between the groups. Simultaneous splenectomy and episodes of antibody-related rejection were significant risk factors associated with infection-related death in multivariate analyses.

CONCLUSION

Although simultaneous splenectomy does not increase the incidence of infection, simultaneous splenectomy definitely carries risks of infection-related mortality in liver transplantation.

Clinical efficacy of simultaneous splenectomy in liver transplant recipients with hepatitis C virus

BACKGROUND

Interferon (IFN) therapy is a well-established antiviral treatment for hepatitis C virus (HCV) - infected patients. However, susceptibility to thrombocytopenia is a major obstacle in its initiation or continuation, particularly in patients with HCV who underwent liver transplantation (LT). We previously showed that the coexistence of splenomegaly and thrombocytopenia could result in persistent thrombocytopenia after LT. Here we retrospectively evaluated the validity of this criterion for simultaneous splenectomy in recipients with HCV.

PATIENTS AND METHODS

Subjects included 36 recipients with HCV who received LT between January 2006 and February 2012 at Hiroshima University. We analyzed the spleen volume, body surface area, platelet (PLT) count, and rate of completion or continuation with IFN therapy in these recipients.

RESULT

Of these recipients, 30 did not require simultaneous splenectomy according to the criterion, and 24 actually did not receive simultaneous splenectomy. In this group, 21 (87.5%) started IFN therapy. Fifteen (71.4%) of these recipients completed or continued IFN therapy, whereas 13 (61.9%) achieved either a sustained virological response (SVR) or an end-of-treatment response. The PLT count increased to >100,000/mm(3) 1 month after LT in 16 (66.7%) recipients from this group.

CONCLUSION

Our criterion detected the PLT count outcome after LT in recipients with HCV and achieved a better SVR result after IFN therapy.

Impact of simultaneous splenectomy and orthotopic liver transplantation in patients with end-stage liver diseases and splenic hyperfunction

BACKGROUND

Whether splenectomy can be performed simultaneously during liver transplantation in patients with end-stage liver diseases complicated by hypersplenism remains controversial. This study aimed to compare the impact of simultaneous splenectomy on high- and low-risk liver transplant patients with end-stage liver diseases and severe hypersplenism.

METHODS

Forty-two patients with end-stage liver diseases complicated by severe hypersplenism who had undergone orthotopic liver transplantation were enrolled in this study. Splenectomy was performed in 19 of the patients. The 42 patients were grouped according to the risk of liver diseases and operations they received. Patients were considered to be at high-risk if they had at least one of the following conditions: preoperative prothrombin time >5 seconds, portal vein thrombosis, and severe perisplenitis. High-risk patients who had undergone splenectomy were classified into group A, whereas high-risk patients who had not undergone splenectomy were classified into group B. Low-risk patients who had undergone splenectomy were classified into group C, and low-risk patients who had spleen preservation were classified into group D. Operative time, intraoperative blood loss, postoperative bleeding, pulmonary infection, perioperative mortality, and postoperative platelet recovery were analyzed.

RESULTS

Operative time and intraoperative blood loss were greater in group A than in groups B-D (P<0.01), but there was no significant difference between groups C and D (P>0.05). In group A, 3 patients had postoperative bleeding, 5 had pulmonary infection, and 2 had perioperative mortality, which was higher than any other group, but postoperative bleeding, pulmonary infection, and perioperative mortality were similar to those in groups C and D. In patients undergoing simultaneous splenectomy, platelet counts recovered within 6 months after surgery. Thrombocytopenia was sustained in 3 of the 23 patients who did not undergo simultaneous splenectomy.

CONCLUSION

Splenectomy should be avoided during orthotopic liver transplantation in high-risk patients, but this procedure does not increase the operative risk in low-risk patients and may be a valuable method to ensure good postoperative platelet recovery.

Acute appendicitis post liver transplant: a case report and literature review

Although acute appendicitis is common, reported cases after orthotopic liver transplant are rare. A 29-year-old woman presented to the emergency department with right lower-quadrant pain and mild leukocytosis 2 years after having a liver transplant. A computed tomography scan revealed an inflamed appendix. On operation, an injected appendix was noted, and she underwent an uncomplicated laparoscopic appendectomy. Histology confirmed the diagnosis and her postoperative course was unremarkable. Owing to the rarity of these cases and paucity of knowledge on management, a high index of suspicion and immediate intervention are required to prevent major complications. This case is the first successful laparoscopic appendectomy after liver transplant ever reported.

Splenectomy in patients with liver cirrhosis and portal hypertension

In patients with liver cirrhosis and portal hypertension, splenectomy allows to reduce portal vein pressure, improve liver function, reverse leukopenia and thrombocytopenia, prevent small-for-size syndrome after living donor liver transplantation, and help treat hepatocellular carcinoma and viral hepatitis. However, overwhelming postsplenectomy infection (OPSI) and portal venous thrombosis are potentially fatal complications following splenectomy. Therefore, the indications and contraindications for splenectomy should be strictly applied.

Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

Hepatitis C is the most common indication for orthotopic liver transplantation in the United States. Unfortunately, hepatitis C recurs universally in the transplanted liver and is the major cause of decreased graft and patient survival. The combination therapy of interferon and ribavirin has been shown to be the most effective therapy for recurrent hepatitis C. However, pre- and post-transplant hypersplenism often precludes patients from receiving the antiviral therapy. Splenectomy and partial splenic embolization are the two invasive modalities that can correct the cytopenia associated with hypersplenism. In this report we review the two treatment options, their associated outcomes and complications.

Evaluation of standard liver volume formulae for Chinese adults

AIM: To evaluate different standard liver volume (SLV) formula and verify the applicability of the formulae for Chinese adults.

METHODS: Data from 70 cases of living donor liver transplantation (LDLT) performed at our transplantation centers between January 2008 and April 2009 were analyzed. SLV was estimated using our recently reported formula [the Chengdu formula: SLV (mL) = 11.5 × body weight (kg) + 334] and other reported formulae used for Chinese adults. Actual intraoperative liver volumes were obtained from a review of the patients’ medical records.

RESULTS: The actual right liver volume was not significantly different from the estimated right liver volume determined by the Chengdu formula, but was significantly smaller than estimates using the Heinemann, Urata, Vauthey, and Lee formulae (P < 0.01), and significantly larger than estimates using the Fan formula (P < 0.05).

CONCLUSION: The Chengdu formula was demonstrated to be reliable by its application in LDLT.