Mitsuhashi Y, Wakiya T, Ishido K, Kudo D, Kimura N, Sato K, Amagasa J, Shibazuka T, Toyoki Y, Hakamada K
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Transplant Proc. 2018 Nov;50(9):2723-2725. doi: 10.1016/j.transproceed.2018.04.028. Epub 2018 Apr 12.
Living donor liver transplantation (LDLT) is a definitive procedure for splenomegaly caused by liver cirrhosis and portal hypertension, but splenomegaly persists in some patients. The aim of this study was to clarify the long-term changes in the spleen volume after LDLT.
The 13 pediatric patients who survived for >8 years after LDLT were retrospectively analyzed. We calculated the spleen volume/standard spleen volume (SV/SSV) ratio by automated computed tomography (CT) volumetry. We assessed the spleen volumes before LDLT, at roughly postoperative week (POW) 4, at postoperative year (POY) 1, at POY 5, and at POY 10.
With regard to SV as evaluated by CT volumetry, there were no consistent trends, with median values as follows: before LDLT, 282.5 (71-641) cm; POW 4, 252 (109-798) cm; POY 1, 222.5 (97-948) cm; POY 5, 263.5 (123-564) cm; and POY 10, 377 (201-1080) cm. In contrast, the SV/SSV ratio decreased chronologically as follows: before LDLT, 5.0 (0.7-6.0); POW 4, 3.7 (2.3-4.3); POY 1, 2.2 (1.7-6.3); POY 5, 1.7 (1.1-5.4); and POY 10, 1.4 (1.1-6.9). In the remote phase after LDLT, many cases showed a trend toward an improved SV/SSV ratio, but splenomegaly was prolonged without improvement in 3 cases (23.1%) with portal vein complications and advanced fibrosis. Furthermore, all 3 cases showed a decreased platelet count due to hypersplenism.
Splenomegaly requires a long time to demonstrate an improvement. In cases without an improvement of splenomegaly, we should suspect abnormalities in the graft liver and portal hemodynamics.
活体供肝肝移植（LDLT）是治疗肝硬化和门静脉高压所致脾肿大的一种确定性手术，但部分患者脾肿大仍持续存在。本研究旨在阐明LDLT术后脾脏体积的长期变化。
对13例LDLT术后存活超过8年的儿科患者进行回顾性分析。通过自动计算机断层扫描（CT）容积测量法计算脾脏体积/标准脾脏体积（SV/SSV）比值。我们评估了LDLT术前、术后约第4周（POW 4）、术后第1年（POY 1）、术后第5年和术后第10年的脾脏体积。
就CT容积测量法评估的SV而言，无一致趋势，中位数如下：LDLT术前，282.5（71 - 641）cm³；POW 4，252（109 - 798）cm³；POY 1，222.5（97 - 948）cm³；POY 5，263.5（123 - 564）cm³；POY 10，377（201 - 1080）cm³。相比之下，SV/SSV比值随时间呈如下下降趋势：LDLT术前，5.0（0.7 - 6.0）；POW 4，3.7（2.3 - 4.3）；POY 1，2.2（1.7 - 6.3）；POY 5，1.7（1.1 - 5.4）；POY 10，1.4（1.1 - 6.9）。在LDLT后的远期，许多病例显示SV/SSV比值有改善趋势，但3例（23.1%）门静脉并发症和晚期纤维化患者的脾肿大持续存在且无改善。此外，所有3例均因脾功能亢进导致血小板计数下降。
脾肿大需要很长时间才能显示出改善。在脾肿大无改善的病例中，我们应怀疑移植肝脏和门静脉血流动力学存在异常。
