Improved graft function in liver-transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome?

Published

Journal Article

AIM: To describe the functional effect of partial splenic embolization (PSE) in liver-transplanted (LT) patients with hypersplenism and hepatitis C virus (HCV) recurrence. PATIENTS AND METHODS: From May 2002 to May 2005, five LT patients with persistent hypersplenism, viral recurrence and graft dysfunction underwent PSE prior to pegylated interferon/ribavirin (peg-IFN/RBV). RESULTS: The mean splenic size was 19.5 cm (16-21) and there was evidence of an enlarged splenic artery (10.7+/-1 mm). PSE produced a median splenic infarction of 90% and a significant reduction in the splenic artery diameter to 5.8+/-0.4 mm (p=0.04). PSE significantly improved hematologic parameters, bilirubin levels, prothrombin activity, international normalized ratio and the Model for End-stage Liver Disease (MELD) score despite high HCV-RNA (6.2 log10 IU/mL). It was demonstrated histologic amelioration of ischemic changes in all subjects. PSE allowed the safe use of full-dose peg-IFN plus RBV in all subjects. CONCLUSIONS: In HCV LT patients with chronic graft dysfunction and cholestasis the improvement in the liver function following PSE might be due to the reversal of an undiagnosed splenic artery steal syndrome related to chronic hypersplenism masked by HCV recurrence.

Full Text

Cited Authors

  • Bárcena, R; Moreno, A; Foruny, JR; Moreno, A; Sánchez, J; Gil-Grande, L; Blázquez, J; Nuño, J; Fortún, J; Rodriguez-Gandía, MA; Otón, E

Published Date

  • July 2006

Published In

Volume / Issue

  • 20 / 4

Start / End Page

  • 517 - 523

PubMed ID

  • 16842531

Pubmed Central ID

  • 16842531

Electronic International Standard Serial Number (EISSN)

  • 1399-0012

International Standard Serial Number (ISSN)

  • 0902-0063

Digital Object Identifier (DOI)

  • 10.1111/j.1399-0012.2006.00516.x

Language

  • eng