Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 14, 2008; 14(26): 4245-4248
Published online Jul 14, 2008. doi: 10.3748/wjg.14.4245
Successful laparoscopic splenectomy after living-donor liver transplantation for thrombocytopenia caused by antiviral therapy
Hiroyuki Kato, Masanobu Usui, Yoshinori Azumi, Ichiro Ohsawa, Masashi Kishiwada, Hiroyuki Sakurai, Masami Tabata, Shuji Isaji
Hiroyuki Kato, Masanobu Usui, Yoshinori Azumi, Ichiro Ohsawa, Masashi Kishiwada, Hiroyuki Sakurai, Masami Tabata, and Shuji Isaji, Department of Hepatobiliary Pancreatic Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
Author contributions: Tabata M and Usui M were involved in performing the surgery; Kato H, Usui M and Isaji S wrote the paper; Isaji S supervised preparation of the manuscript and edited the final version for publication; All authors read and approved the manuscript.
Correspondence to: Hiroyuki Kato, Department of Hepatobiliary Pancreatic Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan. kato0719@clin.medic.mie-u.ac.jp
Telephone: +81-59-2321111
Fax: +81-59-2315253
Received: April 7, 2008
Revised: May 20, 2008
Accepted: May 27, 2008
Published online: July 14, 2008
Abstract

Although interferon (IFN) based therapy for recurrent hepatitis C virus (HCV) infection after liver transplantation has been widely accepted, it induces various adverse effects such as thrombocytopenia, resulting in its interruption. Recently, concomitant splenectomy at the time of living donor liver transplantation (LDLT) has been tried to overcome this problem, but this procedure leads to several complications such as excessive intraoperative bleeding and serious infection. A 60-year-old female received LDLT using a left lobe graft from her second son for liver failure caused by hepatitis C-related cirrhosis. Six months after LDLT, she was diagnosed as recurrent HCV infection by liver biopsy. IFN monotherapy was started from 7 mo after LDLT and her platelet count decreased to less than 50 000/&mgr;L, which thus made it necessary to discontinue the treatment. We decided to attempt laparoscopic splenectomy (LS) under general anesthesia. Since intra-abdominal findings did not show any adhesion formations around the spleen, LS could be successfully performed. After LS, since her platelet count immediately increased to 225 000/&mgr;L 14 d after operation, IFN therapy was restarted and we could convert the combination therapy of IFN and ribavirin, resulting in no detectable viral marker. In conclusion, LS can be performed safely even after LDLT, and LS after LDLT is a feasible and less invasive modality for thrombocytopenia caused by antiviral therapy.

Keywords: Concomitant splenectomy; Portal vein thrombosis; Ribavirin