Splenic Artery Ligation Versus Splenectomy for Portal Inflow Modulation in Adult Living Donor Liver Transplant:...

Area of Science:

• Hepatobiliary surgery
• Transplantation immunology
• Surgical techniques

Background:

• Portal inflow modulation is crucial in living donor liver transplantation (LDLT) for patients with portal hypertension and small grafts.
• Current techniques aim to optimize graft function and prevent complications.

Purpose of the Study:

• To compare the efficacy and outcomes of splenic artery ligation versus splenectomy for portal inflow modulation in LDLT.
• To determine if splenic artery ligation is non-inferior to splenectomy in managing portal hypertension and preventing graft dysfunction.

Main Methods:

• A comparative study of 31 patients undergoing splenic artery ligation versus 22 patients who underwent splenectomy for LDLT.
• Analysis of demographic data, graft characteristics, operative times, portal vein pressure, and incidence of small-for-size syndrome.

Main Results:

• Splenic artery ligation patients received smaller grafts (GRWR 0.89 vs 1.19) and fewer right lobes compared to splenectomy patients.
• Both techniques effectively reduced portal vein pressure and showed no significant difference in the incidence of small-for-size syndrome.
• Splenic artery ligation resulted in a significantly shorter operative time (8.85 vs 10.49 hours).

Conclusions:

• Splenic artery ligation is not inferior to splenectomy for portal inflow modulation in LDLT patients with portal hypertension.
• Splenic artery ligation offers a potentially safer and more efficient alternative, particularly when smaller grafts are used.