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Splenic infarction complicating pediatric liver transplantation: incidence and CT appearance
S C Lehar1, A B Zajko, B Koneru
1Department of Radiology, University of Pittsburgh School of Medicine, PA.
Insights
Pediatric liver transplant patients frequently develop splenic infarction, especially when the splenic artery is ligated during surgery. This finding highlights a key surgical complication impacting spleen health post-transplant.
Area of Science:
- Pediatric Surgery
- Transplant Surgery
- Radiology
Background:
- Liver transplantation in children often requires splenic artery ligation.
- Splenic infarction is a recognized postoperative complication.
Purpose of the Study:
- To determine the incidence and CT appearance of splenic infarction in pediatric liver transplant recipients.
- To correlate splenic infarction with vascular causes related to the surgical procedure.
Main Methods:
- Retrospective review of 94 pediatric liver transplant cases over 2 years.
- Postoperative computed tomography (CT) scans were analyzed for splenic infarction.
- Correlation of infarction occurrence with splenic artery ligation status.
Main Results:
- 28% (26/94) of pediatric liver transplant patients developed splenic infarction on CT.
- Splenic infarction occurred within 2 weeks post-transplant, appearing as hypodense lesions.
- 56% (22/39) of patients with splenic artery ligation developed infarction, versus 7% (4/55) without ligation.
Conclusions:
- Splenic infarction is common in pediatric liver transplant recipients.
- Ligation of the splenic artery significantly increases the risk of splenic infarction.
- CT is effective in diagnosing splenic infarction and assessing its extent.
Abstract:
In children it is often necessary to ligate the splenic artery and the main collateral supply to the spleen during liver transplantation. The complication of splenic infarction has been observed on postoperative CT in such patients. The purpose of our study was to determine the incidence and CT appearance of splenic infarction and to correlate its occurrence with a vascular cause related to the operative procedure. During a 2 year period, 26 of 94 (28%) children receiving liver transplants developed splenic infarction as shown by CT. Infarction generally occurred within 2 weeks of transplantation. Computed tomography demonstrated variable portions of splenic involvement with hypodense lesions. Twenty-two of 39 (56%) patients whose splenic artery was ligated developed splenic infarctions. Only 4 of 55 (7%) patients whose splenic artery was left intact had splenic infarctions on postoperative CT. We conclude that there is an increased incidence of splenic infarction in pediatric liver transplant recipients. The incidence of infarction is related to ligation of the splenic artery and collateral pathways.