Partial splenic embolization for hypersplenism before and after liver transplantation

Area of Science:

• Interventional Radiology
• Hepatology
• Transplant Surgery

Background:

• Hypersplenism, characterized by thrombocytopenia and neutropenia, poses risks including overwhelming post-splenectomy sepsis (OPSS) and mortality.
• Splenectomy is a traditional treatment but carries significant perioperative complications.
• Partial splenic embolization (PSE) presents a minimally invasive alternative to manage hypersplenism.

Purpose of the Study:

• To evaluate the efficacy and safety of PSE in patients with hypersplenism.
• To assess PSE outcomes in patients with portal hypertension awaiting liver transplantation.
• To assess PSE outcomes in patients with persistent hypersplenism post-orthotopic liver transplantation (OLTx).

Main Methods:

• Six patients (3 pre-OLTx, 3 post-OLTx) with hypersplenism underwent selective percutaneous splenic artery embolization.
• Embolization targeted the lower pole of the spleen using microcoils or PVA particles to reduce flow by 30-50%.
• Patients were monitored via CT scans and blood counts (platelets, WBC) for a mean of 26 months (pre-transplant) and 37 months (post-transplant).

Main Results:

• All six patients achieved persistent resolution of thrombocytopenia and neutropenia post-PSE.
• No procedure-related complications were observed.
• One post-transplant patient required splenectomy for pain due to persistent splenomegaly.

Conclusions:

• Partial splenic embolization is a safe and effective treatment for hypersplenism in patients with portal hypertension and those post-OLTx.
• PSE provides a viable non-operative option, avoiding the risks associated with splenectomy.
• Further studies with larger cohorts are warranted to confirm these findings.