Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients

Table 1 Patients’ characteristics

	Nonsplenectomy (n = 85)	Splenectomy (n = 35)	P value
Age (yr), median (range)	57 (37-69)	57 (37-69)	0.667
Gender, n (%)			0.107
Male	67 (78.8)	22 (62.9)
Female	18 (21.2)	13 (37.1)
BMI, median (range)	24.2 (17.4-43.8)	24.6 (18.4-43.3)	0.707
Underlying liver disease, n (%)
HBV	66 (77.6)	14 (40.0)	< 0.001a
HCV	22 (25.9)	23 (65.7)	< 0.001a
Alcoholism	13 (15.3)	4 (11.4)	0.775
Signs of portal hypertension, n (%)
Ascites	43 (50.6)	19 (54.3)	0.841
Hepatic encephalopathy	35 (41.2)	13 (37.1)	0.838
Varices bleeding	19 (22.4)	12 (34.3)	0.251
Comorbidity, n (%)
Hypertension	20 (23.5)	9 (25.7)	0.817
Diabetes mellitus	40 (47.1)	11 (31.4)	0.155
Preoperative serum tests, median (range)
White blood count (/uL)	4600 (1480-11200)	3500 (1350-12200)	0.120
Platelet count (/uL)	80000 (26000-279000)	64000 (27000-155000)	0.003a
Neutrophil–lymphocyte ratio	2.44 (0.51-24.18)	3.2 (0.91-21.33)	0.273
Platelet–lymphocyte ratio	78.49 (36.80-284.01)	71.19 (28.53-188.08)	0.386
Total bilirubin (mg/dL)	1.4 (0-38.9)	1.6 (0.4-57.1)	0.984
Creatinine (mg/dL)	0.9 (0.4-10.1)	0.8 (0.5-1.3)	0.578
Ammonia (ug/dL)	99 (0-337)	99 (30-560)	0.737
Albumin (g/dL)	3.2 (1.2-5.3)	3.3 (2.2-5.1)	0.922
Glucose (mg/dL)	115 (0-457)	118 (82-312)	0.956
INR	1.1 (0.9-2.7)	1.2 (0.9-2.1)	0.819
MELD scores	11 (6-32)	11 (6-30)	0.494
AFP (ng/mL)	7.0 (0.5-1190.0)	14.0 (2.0-2170.0)	0.012a
Surgical factors
Surgical type, n (%)			0.276
DDLT	26 (30.6)	6 (17.1)
LDLT	56 (65.9)	28 (80)
SLT	3 (3.5)	1 (2.9)
Graft type, n (%)			0.120
Whole graft	27 (31.8)	6 (17.1)
Partial graft	58 (68.2)	29 (82.9)
GRWR < 0.8	12 (14.1)	6 (17.1)	0.673
Blood loss (mL), median (range)	1600 (200-14400)	1350 (260-11000)	0.519
Operative time (minutes), median (range)	552 (360-1035)	630 (420-870)	0.001a
Pathology
Tumor size (cm)	2.2 (0-6.5)	2.5 (0-6.2)	0.140
Tumor number, n (%)			0.404
0 or 1	58 (68.2)	21 (60.0)
2 or 3	27(31.8)	14 (40.0)
Tumor necrosis, n (%)	49 (58.3)	20 (57.1)	1.000
Lymphovascular invasion, n (%)	6 (7.1)	5 (14.3)	0.297
Outcomes
Hospital stays, median (range) (d)	21 (0-85)	18 (5-116)	0.810
HCC Recurrence, n (%)	16 (18.8)	15 (42.9)	0.011a
Secondary cancer, n (%)	5 (6.4)	0	0.322
Mortality, n (%)	9 (10.6)	11 (31.4)	0.013a

^aP < 0.05.

BMI: Body mass index; HBV: Hepatitis B virus; HCV: Hepatitis C virus; GRWR: Graft-to-recipient weight ratio; INR: International normalized ratio; MELD: The Model for End-stage Liver Disease; AFP: α-fetoprotein; LT: Liver transplantation; DDLT: Deceased donor liver transplantation; LDLT: Living donor liver transplantation; SLT: Split liver transplantation.