Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2021; 27(7): 654-665
Published online Feb 21, 2021. doi: 10.3748/wjg.v27.i7.654
Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism
Wen-Tao Jiang, Jian Yang, Yan Xie, Qing-Jun Guo, Da-Zhi Tian, Jun-Jie Li, Zhong-Yang Shen
Wen-Tao Jiang, Jian Yang, Yan Xie, Qing-Jun Guo, Da-Zhi Tian, Jun-Jie Li, Zhong-Yang Shen, Department of Liver Transplantation, Tianjin First Center Hospital, First Clinical Institute of Tianjin Medical University, Tianjin 300192, China
Wen-Tao Jiang, Yan Xie, Qing-Jun Guo, Da-Zhi Tian, Jun-Jie Li, Zhong-Yang Shen, Organ Transplantation Center, Tianjin First Center Hospital, Tianjin 300192, China
Jian Yang, Department of Hepatological Surgery, Zibo Central Hospital, Zibo 255000, Shandong Province, China
Author contributions: Jiang WT is the first author; Yang J and Xie Y are the co-first authors; Jiang WT contributed to study conception; Yang J and Xie Y contributed to data collection; Yang J contributed to manuscript drafting; Jiang WT, Yang J, Xie Y, Guo QJ, Tian DZ, Li JJ and Shen ZY contributed critical revision of the manuscript for important intellectual content.
Supported by National Natural Science Foundation of China, No. 81870444; Tianjin Natural Science Foundation, No. 19JCQNJC10300; and Spring Bud Plan of Tianjin First Central Hospital, No. TFCHCL201801.
Institutional review board statement: This study was approved by the Ethics Committee of Tianjin First Central Hospital (Approval No. 2019N168KY).
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry. The registration identification number is ChiCTR-TRC-10001070.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Participants gave informed consent for data sharing.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhong-Yang Shen, MD, Dean, Doctor, Department of Liver Transplantation, Tianjin First Center Hospital, First Clinical Institute of Tianjin Medical University, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. yangjian06281@126.com
Received: November 25, 2020
Peer-review started: November 25, 2020
First decision: December 8, 2020
Revised: December 20, 2020
Accepted: January 13, 2021
Article in press: January 13, 2021
Published online: February 21, 2021
Abstract
BACKGROUND

The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation (LT). However, splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegaly.

AIM

To examine the feasibility of performing partial splenectomy during LT in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism.

METHODS

Between October 2015 and February 2019, 762 orthotopic LTs were performed for patients with end-stage liver diseases in Tianjin First Center Hospital. Eighty-four cases had advanced cirrhosis combined with severe splenomegaly and hypersplenism. Among these patients, 41 received partial splenectomy during LT (PSLT group), and 43 received only LT (LT group). Patient characteristics, intraoperative parameters, and postoperative outcomes were retrospectively analyzed and compared between the two groups.

RESULTS

The incidence of postoperative hypersplenism (2/41, 4.8%) and recurrent ascites (1/41, 2.4%) in the PSLT group was significantly lower than that in the LT group (22/43, 51.2%; 8/43, 18.6%, respectively). Seventeen patients (17/43, 39.5%) in the LT group required two-stage splenic embolization, and further splenectomy was required in 6 of them. The operation time and intraoperative blood loss in the PSLT group (8.6 ± 1.3 h; 640.8 ± 347.3 mL) were relatively increased compared with the LT group (6.8 ± 0.9 h; 349.4 ± 116.1 mL). The incidence of postoperative bleeding, pulmonary infection, thrombosis and splenic arterial steal syndrome in the PSLT group was not different to that in the LT group, respectively.

CONCLUSION

Simultaneous PSLT is an effective treatment and should be performed in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism to prevent postoperative persistent hypersplenism.

Keywords: Liver transplantation, Partial splenectomy, Hypersplenism, Splenomegaly, Liver cirrhotic, Megalosplenia

Core Tip: In this article, for the first time, we describe partial splenectomy during liver transplantation (PSLT) in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism. PSLT can effectively alleviate the severity of postoperative hypersplenism and ascites in megalosplenia patients.