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
ARTICLE HIGHLIGHTS
Research 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. Persistent hypersplenism-related pancytopenia may interfere with the management of immunosuppressive therapy. Splenomegaly may further result in excessive portal pressure or splenic artery steal syndrome. The resulting decrease in hepatic arterial inflow can then affect liver graft function.

Research motivation

The most common therapies for splenomegaly and hypersplenism are total splenectomy during LT and selective splenic artery embolization after LT, but they have considerable limitations. Cirrhosis with severe splenomegaly and hypersplenism is common, yet satisfactory treatment is lacking. To realize this need, we first proposed and designed the procedure of partial splenectomy during LT (PSLT), which is an all-in-one treatment for post-LT complications.

Research objectives

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

Research methods

Between October 2015 and February 2019, 762 cases of classic orthotopic LT were performed at our institution. Among these, there were 84 cases of advanced cirrhosis combined with severe splenomegaly and hypersplenism. Forty-one cases received PSLT (PSLT group), and 43 cases received only LT with no intervention (LT group). Patient characteristics, intraoperative parameters, and postoperative outcomes were compared between the LT and PSLT groups and retrospectively analyzed.

Research results

The incidence of postoperative hypersplenism and recurrent ascites in the PSLT group was significantly lower than that in the LT group. Seventeen patients 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 were relatively increased compared with the LT group. The incidence of postoperative bleeding, pulmonary infection, thrombosis and splenic arterial steal syndrome in the PSLT group was similar to that in the LT group, respectively.

Research conclusions

PSLT can reduce the incidence of postoperative hypersplenism and recurrent ascites, and reduce the risk of secondary splenic embolization and splenectomy, but the operation time and intraoperative blood loss were increased.

Research perspectives

According to our experience, patients with preoperative severe splenomegaly and hypersplenism are more likely to have intractable hypersplenism after LT, and PSLT is recommended.