Spleen size changes in pediatric liver transplant recipients with functioning grafts

Hypersplenism and splenomegaly are common pathologic conditions in patients with chronic liver failure. Herein we discuss the prognosis of these conditions after orthotopic liver transplantation (OLT) in pediatric patients with functional grafts.

Forty-eight pediatric patients with cirrhosis underwent OLT. Seven patients were excluded from the study because of death within 1 month. Patients were divided into 2 groups: group A consisted of patients with nonfunctioning grafts (n=9), and group B, patients with functioning grafts (n=32). We measured preoperative leukocytes, platelet counts, and spleen sizes. Postoperative measurements were performed at 1 week as well as at 1, 3, 6, and 12 months after grafting. Statistical analyses were performed to evaluate reversal of hypersplenism and splenomegaly after OLT.

No change in hypersplenism and splenomegaly was seen in group A, whereas in group B, a statistically significant change was seen in spleen sizes with improvement in hypersplenism after OLT, although persistent splenomegaly was observed in 17 patients.

Reversal of hypersplenism and improvement of splenomegaly can be expected after OLT in pediatric patients with functioning grafts. Although the literature points to the duration of chronic liver disease as a causative factor for persistent splenomegaly in adults, there must be other causes, as the condition is seen in pediatric patients as well.