Proximal Splenic Artery Embolization For Refractory Ascites And Hydrothorax After Liver Transplant: A Single Center Analysis Of Factors Associated With Success

L. Lomaglio, G. D'Amico, S. Armanyous, T. Diago Uso, K. Hashimoto, B. Eghtesad, M. Fujiki, F. Aucejo, K. Sasaki, C. Kwon, C. Coppa, M. Bayona Molano, C. Lindenmeyer, C. Miller, C. Quintini

Cleveland Clinic, Cleveland, OH

Meeting: 2019 American Transplant Congress

Abstract number: 229

Keywords: Hemodynamics, Hepatic artery, Post-operative complications, Renal function

Session Information

Session Name: Concurrent Session: Liver Transplant Complications and Retransplantation I

Session Type: Concurrent Session

Date: Monday, June 3, 2019

Session Time: 2:30pm-4:00pm

Presentation Time: 3:18pm-3:30pm

Location: Ballroom A

*Purpose: The aims of this study were to (1) assess the efficacy of proximal SAE for the treatment of RA and RH caused by portal hyperperfusion (PHP) after LT and to (2) identify clinical factors associated with early and late resolution of RA and RH after SAE.

*Methods: A retrospective analysis of all patients who underwent SAE for RA and RH after LT between 2008 and 2017 was conducted. Independent t-test was used to test differences between the quantitative variables. Paired t-test was used to compare values before and after SAE. A linear model was built to study the effect of the operative intervention and follow-up duration on eGFR while adjusting for the correlation among observations of the same subjects.

*Results: Thirty patients underwent SAE after LT between 2008-2017. The mean interval of follow-up was 54 ± 34 months. Of these patients, 19 (64%) underwent SAE for RA, 1 (3%) underwent SAE for RH, and 10 (33%) underwent SAE for both RA and RH post-operatively.All patients who underwent SAE experienced complete resolution of RA, RH or both by the end of clinical follow-up. Timing of resolution of RA/RH was divided into early (<3 months after SAE) and late (>3 months after SAE). The mean time to early resolution was 56 ± 11 days (24 patients); the mean time to late resolution was 135 ± 79 days (6 patients) (p<0.034). Factors associated with early versus late resolution of symptoms are summarized in Table 1. All patients who underwent SAE after LT were noted to have improved estimated glomerular filtration rate (eGFR) over the period of clinical follow-up. The magnitude of improvement in eGFR over time was significantly greater in patients with pre-SAE renal insufficiency (pre-SAE eGFR of <60 mL/min/1.73 meters²). In this subset of patients, the mean eGFR after SAE was significantly higher than the pre-SAE level (increased by 83% at 6 months after SAE, p < 0.001).

*Conclusions: SAE is an effective method for the therapy of RA and RH after LT. The absence of renal insufficiency before SAE predicts early resolution of RA and RH. However, SAE significantly improves renal function after LT in patients with pre-existing renal insufficiency. We suggest that a predictive model for successful SAE for the therapy of RA/RH after LT be built based on factors we identified as predictive of early resolution of symptoms.

Factors associated with early versus late resolution of symptoms
	Early resolution(n=24)M±SD	Late resolution (n=6)M±SD	p-Value
Age (year)	56 ± 10	63 ± 66	0.03
Pre-SAE e GFR (mL/min/1.73 meters2)	77 ± 48	43 ± 26	0.03
Splenic/hepatic artery ratio	1.9 ± 0.04	1.6 ±. 0.1	0.04
Spleen/liver volume ratio (cm3)	0.98 ± 0.3	0.7 ± 0.2	0.016
Spleen volume (cm3)	1337 ± 413	953 ± 287	0.037
Intraoperative PV flow(ml/min/100g)	139 ± 49	102 ± 13	0.004
Pre-SAE PV velocity (cm/sec)	80 ± 26	57 ± 4.5	0.0001

To cite this abstract in AMA style:

Lomaglio L, D'Amico G, Armanyous S, Uso TDiago, Hashimoto K, Eghtesad B, Fujiki M, Aucejo F, Sasaki K, Kwon C, Coppa C, Molano MBayona, Lindenmeyer C, Miller C, Quintini C. Proximal Splenic Artery Embolization For Refractory Ascites And Hydrothorax After Liver Transplant: A Single Center Analysis Of Factors Associated With Success [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/proximal-splenic-artery-embolization-for-refractory-ascites-and-hydrothorax-after-liver-transplant-a-single-center-analysis-of-factors-associated-with-success/. Accessed November 21, 2024.

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