What Are Risk Factors for Graft Loss in Patients Who Underwent Simultaneous Splenectomy During Living-donor Liver...

Area of Science:

• Hepatology
• Transplantation Surgery
• Immunology

Background:

• Portal venous pressure modulation, including splenectomy (Spx), is recognized for preventing complications post-living-donor liver transplantation (LDLT).
• Limited data exists on risk factors for graft loss when splenectomy is performed simultaneously during LDLT.

Purpose of the Study:

• To identify independent predictors of graft loss after simultaneous splenectomy during living-donor liver transplantation.

Main Methods:

• A retrospective analysis of 655 LDLT recipients from 1997 to 2021.
• Patients were divided into simultaneous splenectomy (n=461) and no-splenectomy (n=194) groups.
• Multivariate analysis was used to identify independent predictors of graft loss.

Main Results:

• The splenectomy group showed significantly lower postoperative bilirubin, ascites, and INR.
• Incidences of small-for-size graft syndrome, acute cellular rejection, and sepsis were lower in the splenectomy group.
• Graft survival was significantly better in the splenectomy group (HR, 1.788). Independent predictors of graft loss within 6 months included platelet count ≤4.0×10^4/mm³, donor age ≥60 years, and portal venous pressure ≥20 mm Hg.

Conclusions:

• Simultaneous splenectomy is a safe procedure that improves outcomes for most LDLT recipients.
• Specific risk factors—low platelet count, advanced donor age, and elevated portal pressure—identify patients at higher risk for graft loss.