Introduction: The use of lower volume liver grafts has the potential to expand the donor pool in adult-to-adult live donor liver transplantation (LDLT), but is associated with an increased risk for small for size syndrome (SFSS). We investigated the long-term outcomes of LDLT recipients who developed SFSS and examined the efficacy of splenectomy as a strategy to modulate portal venous inflow.

Methods: Retrospective study of 520 adult-to-adult LDLT from April-2000 to June-2015. SFSS was diagnosed by graft dysfunction (persistent hyperbilirrubinemia >60[micro]mol/L and moderate/severe ascites) without an identifiable cause, or presence of intraoperative parenchymal congestion in the context of a low graft volume to portal flow.

Results: 32 LDLT recipients (6.2%) were diagnosed with SFSS. 26 recipients who developed SFSS and underwent splenectomy (group 1) were compared with 6 recipients who developed SFSS but did not undergo splenectomy (group 2) and then compared with 488 LDLT recipients without SFSS (group 3). Group 1 had a significantly higher graft survival (96.2/90.5/90.5% vs 33.3/16.7/16.7%, p=0.0001) and patient survival (100/100/100% vs 66.7/33.3/33.3%, p=0.0001) than Group 2 at 1/3/5 years respectively. Group 1 had a higher incidence of postoperative bacterial infections (46.2% vs 20.5%, p=0.004) and portal vein thrombosis (15.4% vs 2.3%, p=0.005) than group 3, but equivalent incidence of retransplantation (7.7% vs 6.1%, p=0.49) as well as graft and patient survival (96.2/90.5/90.5% vs 90.4/83.7/81.2% and 100/100/100% vs 92.9/86.4/84.7%) at 1/3/5 years.

Conclusion: In patients who develop SFSS after LDLT, splenectomy is a rescue therapy that decreases the chance of graft failure, achieving long-term outcomes comparable to LDLT recipients without SFSS. Poor outcomes in patients with SFSS without splenectomy highlight the importance of performing splenectomy as a method to modulate portal flow in these grafts.

CITATION INFORMATION: Dib M, Goldaracena N, Barbas A, Marquez M, Sapisochin G, Beriault C, Selzner N, McGilvray I, Renner E, Greig P, Lilly L, Ghanekar A, Cattral M, Selzner M, Grant D. Long-Term Outcomes After Splenectomy for Small-for-Size Syndrome in Live Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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