Chen T-Y, Chen C-L, Huang T-L, Tsang L L-C, Ou H-Y, Yu C-Y, Hsu H-W, Cheng Y-F
Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2012 Apr;44(3):752-4. doi: 10.1016/j.transproceed.2012.01.044.
The aim of this study was to evaluate predictive factors for persistent splenomegaly and hypersplenism after living donor liver transplantation (LDLT).
From January 2008 to June 2010, 159 adult patients (116 males and 43 females) who underwent living donor liver transplantation (LDLT) had pre- and post-LDLT computed tomography angiography and survived more than 6 months. Patients with post-LDLT portal vein stenosis were excluded from this study. We analyzed the impact for persistent splenomegaly and hypersplenism after LDLT of pre-LDLT spleen volume, main portal vein (PV) size, coronary vein (CV) size and platelet levels.
While 38 patients displayed splenomegaly, 121 showed normal spleen volumes at 6 months after LDLT (LDLT). There were 119 thrombocytopenic versus 40 normal platelet patients at 6 months post-LDLT. The persistent splenomegaly patients showed significantly larger pre-LDLT spleen volume, larger PV and CV sizes as well as lower platelet levels before (×10,000/mL) and 1 month after LDLT (×10,000/mL). Multiple logistic regression analysis showed spleen volume and platelet count at 1 month posttransplant to be the only variables associated with persistent splenomegaly at 6 months post. Persistent thrombocytopenia at 6 months post-LDLT was associated with significantly larger pre-LDLT spleen volume, larger CV size, and lower platelet levels including P0 and P1 m. Multiple logistic regression analysis showed that platelet count at 1 week and at 1 month post-LDLT were the variables associated with persistent thrombocytopenia at 6 months post-LDLT.
Spleen volume and platelet levels at 1 month after LDLT may predict persistent splenomegaly at 6 months post-LDLT. The predictive factors for hypersplenism at 6 months post-LDLT may be platelet levels at 1 week and at 1 month post-LDLT.
本研究旨在评估活体肝移植（LDLT）后持续性脾肿大和脾功能亢进的预测因素。
2008年1月至2010年6月，159例接受活体肝移植（LDLT）的成年患者（116例男性和43例女性）在LDLT前后接受了计算机断层血管造影检查，且存活超过6个月。本研究排除了LDLT后门静脉狭窄的患者。我们分析了LDLT前脾脏体积、门静脉主干（PV）大小、冠状静脉（CV）大小和血小板水平对LDLT后持续性脾肿大和脾功能亢进的影响。
38例患者在LDLT后6个月出现脾肿大，121例脾脏体积正常。LDLT后6个月，119例患者血小板减少，40例患者血小板正常。持续性脾肿大患者在LDLT前脾脏体积显著更大，PV和CV尺寸更大，且LDLT前（×10,000/mL）和LDLT后1个月（×10,000/mL）血小板水平更低。多因素logistic回归分析显示，移植后1个月的脾脏体积和血小板计数是与移植后6个月持续性脾肿大相关的唯一变量。LDLT后6个月持续性血小板减少与LDLT前脾脏体积显著更大、CV尺寸更大以及包括P0和P1 m在内的更低血小板水平相关。多因素logistic回归分析显示，LDLT后1周和1个月的血小板计数是与LDLT后6个月持续性血小板减少相关的变量。
LDLT后1个月的脾脏体积和血小板水平可能预测LDLT后6个月的持续性脾肿大。LDLT后6个月脾功能亢进的预测因素可能是LDLT后1周和1个月的血小板水平。
