Splenic infarction complicating pediatric liver transplantation: incidence and CT appearance.

In children it is often necessary to ligate the splenic artery and the main collateral supply to the spleen during liver transplantation. The complication of splenic infarction has been observed on postoperative CT in such patients. The purpose of our study was to determine the incidence and CT appearance of splenic infarction and to correlate its occurrence with a vascular cause related to the operative procedure. During a 2 year period, 26 of 94 (28%) children receiving liver transplants developed splenic infarction as shown by CT. Infarction generally occurred within 2 weeks of transplantation. Computed tomography demonstrated variable portions of splenic involvement with hypodense lesions. Twenty-two of 39 (56%) patients whose splenic artery was ligated developed splenic infarctions. Only 4 of 55 (7%) patients whose splenic artery was left intact had splenic infarctions on postoperative CT. We conclude that there is an increased incidence of splenic infarction in pediatric liver transplant recipients. The incidence of infarction is related to ligation of the splenic artery and collateral pathways.