Severe portal hyperperfusion after liver transplantation has been shown to cause intrahepatic arterial vasoconstriction secondary to increased washout of adenosine (hepatic artery buffer response). Furthermore, post-transplant portal hyperperfusion can cause in severe cases refractory ascites and hydrothorax. In the past we reported our preliminary experience with the use of splenic artery embolization (SAE) as a way to reduce portal hyperperfusion. Here we present our 5-year experience with SAE in OLT.
Between January, 2007 and December, 2011, 681 patients underwent OLT at our institution. 55 of these patients underwent SAE increased hepatic arterial resistance and portal hyperperfusion (n=42), refractory ascites/hepatic hydrothorax (n=12) and other indications (n=1). SAE was performed by placement of metallic coils +/- thrombogenic material placed in the proximal splenic artery. Efficacy of SAE at modifying hepatic artery flow parameters were assessed using a paired t-test. Spleen/liver volume ratio, an indirect measure of portal hypertension was calculated in the study group and compared to a matched control group. Matching was completed by year of embolization, calculated MELD score, and liver weight with which to compare patients undergoing SAE. Finally, complication rates of patients undergoing SAE were assessed.
Results: SAE resulted in improvements in hepatic artery resistive indices (RI pre/post SAE of 0.92+/- 0.14 and 0.76+/- 0.10 respectively, p<0.00001) and improved hepatic arterial flow 15.6+/- 9.69 and 28.7+/- 14.83, p<0.00001). Calculated splenic volume and spleen/liver volume ratio was correlated with patients requiring SAE compared to matched controls. (p=0.002 and p=0.001 respectively.) Of 55 patients undergoing SAE, 2 were noted to develop some post-operative, self-limited abdominal pain and there was one case of post-splenectomy syndrome. No abscess, significant infections, or bleeding were noted.
Conclusion: splenic artery embolization is a safe and effective technique able to improve hepatic artery flow parameters in patients with elevated portal venous flow and their sequelae.
To cite this abstract in AMA style:Presser N, Tom C, Quintini C, Liu Q, Ahmed N, Kelly D, Hashimoto K, Aucejo F, Eghtesad B, Miller C. Splenic Artery Embolization in Liver Transplantation: A Single Center 5 Year Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/splenic-artery-embolization-in-liver-transplantation-a-single-center-5-year-experience/. Accessed November 30, 2020.
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