Risk Factors for Small-for-Size Syndrome Grade B/C After Simultaneous Splenectomy in Adult Living-Donor Liver...

Area of Science:

• Hepatology
• Transplantation Surgery
• Clinical Risk Factor Analysis

Background:

• Small-for-size syndrome (SFSS) is a significant complication following adult living-donor liver transplantation (LDLT), associated with poor patient outcomes.
• Splenectomy (Spx) has emerged as a potential strategy to mitigate SFSS and improve survival rates in LDLT recipients.

Purpose of the Study:

• To identify independent risk factors for SFSS development in LDLT recipients who underwent concomitant splenectomy.
• To analyze prognostic factors associated with severe SFSS (grade B/C) requiring perioperative portal vein inflow control.

Main Methods:

• A single-center retrospective study analyzed 577 LDLT recipients who underwent splenectomy between 2001 and 2024.
• SFSS grading was performed according to the 2023 International Liver Transplantation Society consensus criteria.
• Multivariate logistic regression was used to identify independent predictors of SFSS grade B/C.

Main Results:

• SFSS grade B/C occurred in 18.2% of patients, correlating with significantly lower 1-year survival (81.9% vs. 93.9%).
• Higher Model for End-stage Liver Disease (MELD) scores, neutrophil-to-lymphocyte ratios (NLR), donor age, and donor BMI were observed in the SFSS B/C group.
• Independent predictors for SFSS grade B/C included NLR ≥ 4.5, MELD score ≥ 30, and donor age ≥ 50 years.

Conclusions:

• Despite splenectomy, nearly one in five LDLT recipients developed SFSS, indicating persistent risk.
• Elevated recipient NLR, MELD score, and advanced donor age are critical risk factors for SFSS post-splenectomy.
• Future strategies should focus on meticulous donor selection and optimized perioperative portal inflow management for high-risk LDLT cases.