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Proximal total splenic artery embolization for refractory hepatic encephalopathy
Harufumi Maki1, Junichi Kaneko2, Junichi Arita1
1Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Clinical Journal of Gastroenterology
|December 3, 2017
Summary
Refractory hepatic encephalopathy (HE) in a liver transplant patient was successfully treated with proximal total splenic artery embolization (TSAE). This less invasive procedure improved portal vein flow and resolved HE symptoms.
Area of Science:
- Hepatology
- Interventional Radiology
- Transplantation Medicine
Background:
- A patient with biliary atresia underwent living-donor liver transplantation at age 22.
- The patient experienced recurrent episodes of refractory hepatic encephalopathy (HE) and late cellular rejection, previously managed with high-dose steroids and transvenous obliteration for a spleno-renal shunt.
Observation:
- A third episode of refractory HE occurred 11 years post-transplant, associated with liver cirrhosis, hypersplenism (Child-Pugh C-10), and superior mesenteric vein (SMV) flow regurgitation despite hepatopetal portal vein flow.
Findings:
- Proximal total splenic artery embolization (TSAE) was performed, successfully redirecting SMV flow to a hepatopetal direction and resolving HE.
- One year post-TSAE, spleen volume decreased by 20% (to 589 mL), and the patient maintained a Child-Pugh score of 8 without overt HE.
Implications:
- Proximal TSAE represents a novel, potentially less invasive treatment option for refractory HE in select liver transplant recipients with hypersplenism and venous flow abnormalities.
- This case highlights the importance of addressing splenic hemodynamics in managing complex post-transplant complications.
