Predictive factors for persistent splenomegaly and hypersplenism after adult living donor liver transplantation.

PURPOSE

The aim of this study was to evaluate predictive factors for persistent splenomegaly and hypersplenism after living donor liver transplantation (LDLT).

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.