Introduction: Portal hypertension in recipients undergoing living donor liver transplant (LDLT) is thought to be one of the main causes of posttransplant graft dysfunction. In this setting, modification of portal flow has been suggested to decrease portal pressure. One possible option to decrease flow, splenic artery ligation (SAL), has been performed in recipients with elevated portal flow. Even though the short-term results with SAL in adult LDLT are excellent, the long-term outcomes and postoperative complications have not been as clearly outlined.

Methods: From August 2010 to August 2017, 141 adult LDLT were performed at our center. Two patients had previous splenectomy and were excluded from this analysis. Of 139 patients, 78 (56%) had SAL preformed and 61 (44%) did not. Indications for SAL performed before reperfusion of the graft included large spleen to native liver volume and GW/RW ratio<0.8. Indications for SAL post-reperfusion included elevated portal pressure (>18), elevated portal flow (>250mls/min/100gm), or decreased hepatic arterial flow (<50mls/min). We compared results in patients with SAL vs without SAL, looking specifically for postoperative complications that may have been due to the SAL.

Results: SAL significantly decreased mean portal pressure (19.2±1.7 pre-SAL vs 15±1.8 post-SAL, p=0.0014) in those patients where SAL was performed after graft reperfusion. Three patients who did not undergo SAL at the time of surgery required splenic artery embolization in the postoperative period due to small for graft size and/or splenic steal syndrome. Of the 78 patients that had SAL, 10(12.8%) developed splenic infarcts as noted on routine CT imaging, but none of these patients developed an abscess or required any invasive treatment for the infarcts. Only 1 patient developed clinically significant pancreatitis in the postoperative period with pseudocyst that was treated with percutaneous drainage. No statistically difference was found in postoperative infection rate between patients with/without SAL(p=0.50). The 1 year patient survival was slightly lower in the SAL group, though not statistically significant (89% vs 84%, p=0.06).

Conclusion: Overall, SAL was safe and effective in decreasing portal pressure in patients undergoing LDLT and was associated with no increased risk of infections postoperatively and minimal risk of pancreatic or splenic complications requiring intervention.

CITATION INFORMATION: Gunay Y., Ganesh S., Molinari M., Tevar A., Hughes C., Humar A. The Safety and Efficacy of Splenic Artery Ligation in Living Donor Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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