Adult living-donor liver transplantation without simultaneous splenectomy

Area of Science:

• Hepatology
• Transplantation Surgery
• Surgical Outcomes

Background:

• The necessity of intraoperative inflow modulation, specifically simultaneous splenectomy and shunt ligation, in living-donor liver transplantation (LDLT) to enhance graft survival and prevent small-for-size syndrome (SFSS) remains a subject of debate.
• These procedures, employed in some centers during LDLT, exert opposing influences on portal hemodynamics, leaving their overall benefits uncertain.

Purpose of the Study:

• To evaluate the impact of graft size on recipient outcomes in adult LDLT performed without simultaneous splenectomy.
• To identify specific factors associated with graft survival in this patient cohort.

Main Methods:

• A retrospective analysis of 234 adult LDLT recipients who did not undergo simultaneous splenectomy.
• Graft size was assessed using the graft-to-recipient weight ratio (GRWR), with a cutoff of 0.7% defining small grafts.

Main Results:

• No significant differences in 1-, 3-, or 5-year graft or patient survival rates were observed between the small-sized graft (GRWR <0.7%) and non-small-sized graft (GRWR ≥0.7%) groups.
• Independent risk factors for graft failure included older donor age (>45 years) and spleen-graft size disproportion (<70%). Recipients with both factors exhibited significantly worse graft survival (P<0.001).
• Post-transplant, recipients showed increased platelet count and graft volume, with decreased portal venous flow and shunt/spleen size, irrespective of graft size.

Conclusions:

• Adult LDLT can be successfully performed without the routine need for simultaneous splenectomy.
• Splenectomy may be considered selectively in cases of significant spleen-graft size disproportion or when utilizing grafts from older donors to mitigate graft failure risk.