*Purpose: Splenectomy is performed in liver transplantation (LT) to regulate the portal vein pressure. Researchers have reported beneficial effects of splenectomy on rejection prevention, protection against small-for-size graft syndrome and therapy for hepatitis C virus. However, there are also serious complications of splenectomy in LT, including infection, thrombosis and hemorrhage. Splenectomy is usually avoided in light of these common complications and indications for splenectomy during LT remain controversial. This meta-analysis aims to assess the prognosis of patients with or without splenectomy during LT.

*Methods: We systematically searched for all the studies that compared the outcomes of candidates with splenectomy (SP group) and those without splenectomy (NSP group) in LT using the MEDLINE, Web of Science and Cochrane Library databases. All studies reporting the outcomes of SP group versus NSP group were further evaluated for inclusion in this meta-analysis. Odds ratio (OR) and 95% confidence intervals (CI) were calculated to compare the pooled data between SP group and NSP group.

*Results: Eleven retrospective trials, involving 2012 liver transplant recipients, were included. SP group showed lower rates of acute rejection (AR) and small-for-size syndrome (SFSS) with an OR equal to 0.59 (95% CI = 0.43-0.82, p=0.001) and 0.29 (95% CI = 0.09-0.95, p = 0.004) respectively, compared to the NSP group. Both groups had a similar 1-year patient mortality and infection rates post-transplantation, however, there were poor 1-year graft outcomes (OR=2.25, 95% CI = 1.24-4.09, p=0.008), high rates of veinous thrombosis (OR=5.36, 95% CI =1.66-17.32, p=0.005) and hemorrhage (OR=2.61, 95% CI = 1.51-4.5, p=0.0006) in the SP groups.

*Conclusions: Candidates that underwent splenectomy in LT had a decreased risk of suffering from AR and SFSS, but have a higher ratio of veinous thrombosis and post operative hemorrhage, and lower rate of graft survival after LT compared to those who do not undergo splenectomy. Thus, the decision to perform a splenectomy for LT candidates needs to be carefully considered and risk versus benefit should be thoroughly weighed.

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