Background. Splenectomy is performed as strategy of modulating the portal vein pressure in most of portal hypertension patients with liver cirrhosis. In liver transplantation, researchers have reported controversial data of splenectomy, either beneficial for preventing rejection, small-for-size graft syndrome, or presence of serious complications including infection, thrombosis and hemorrhage. Therefore, we conducted a meta-analysis to compare the outcomes of patients with or without splenectomy before liver transplantation.

Methods. We systematically searched for papers in PubMed, Embase, and the Cochrane Library database. We extracted data on patient prognosis from studies that compared clinical outcomes of liver transplant recipient with or without splenectomy. Odds ratios and 95% confidence intervals (CI) were calculated to compare the pooled data between splenectomy and non-splenectomy groups.

Results. Eleven retrospective studies, involving 1987 transplant recipients, were included. Meta-analysis of included data showed liver transplant recipients with splenectomy history had significantly poor graft survival (OR 0.59, 95% CI 0.40-0.89, P=0.01), compared with those non splenectomy patients. Both splenectomy and non splenectomy groups had similar outcomes of patient survival (OR 0.77, 95% CI 0.46-1.26, P=0.3) and incidence of acute rejection (OR 0.74, 95% CI 0.5-1.09, P=0.13), And treatment complications including infection (OR 0.79, 95% CI 0.58-1.07, P=0.12), hemorrhage (OR 2.15, 95% CI 0.84-5.56, P=0.11) and (OR 2.37, 95% CI 0.46-12.29, P=0.3) were all comparative irrespective of splenectomy. However, splenectomy recipients showed significantly lower incidence of small-for-size syndrome (SFSS) complication.

Conclusions. Overall, splenectomy had no impact on the incidence of acute rejection, thrombosis, hemorrhage post-operation and patient survival in liver transplant recipients. The only benefit of splenectomy was to decrease the incidence of SFSS, but the graft survival is lower than non splenectomy group. It seems to that splenectomy do not provide enough help for those candidates for liver transplant. Further clinical trials are required to be certified the effect of splenectomy on liver transplantation.

CITATION INFORMATION: Chen M., Lin X., Huang B., He X. Evaluation the Outcomes of Liver Transplant Recipients Underwent Splenectomy: A Meta-Analysis Am J Transplant. 2017;17 (suppl 3).

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