Splenic Artery Embolization in Living Donor Liver Transplant Recipients: Indications, Safety and Clinical Outcomes

Splenic artery embolization (SAE) is a minimally invasive interventional radiology (IR) procedure that plays an important role in the management of complications in a certain subgroup of liver transplant recipients. SAE is technically of two types - proximal (P-SAE) and distal (D-SAE). There is limited data regarding the role of SAE in liver transplant recipients. The purpose of this study was to describe the role and outcomes of SAE in LDLT recipients based on the indications and the type of procedure used.

Twenty-seven consecutive patients who underwent SAE after LDLT at our institute were retrospectively reviewed. Patients were categorized into two groups - those who underwent P-SAE (n = 7) and D-SAE (n = 20). The embolic agents used were coils or plugs in the P-SAE group; and poly vinyl alcohol (PVA) particles in the D-SAE group.

The median follow-up of the study population was 101 days. The mean platelet and lymphocyte counts improved markedly after SAE (P < 0.001 & P < 0.0001, respectively). Refractory ascites was significantly reduced in both the groups (100% in P-SAE & 77.7% in D-SAE). Minor complications were noted in 28.5% in the P-SAE group and 65% in the D-SAE group. Major complications occurred only in the D-SAE group (15%).

Our results support the use of P-SAE for the management of splenic artery steal and small-for-size graft syndromes; and D-SAE for the management of hypersplenism and refractory ascites. Both procedures are safe and effective and the decision to perform proximal or distal SAE should be based on the indications.