From the HPB Surgery and Liver Transplantation Unit, El-Rajhy Liver Hospital, Assiut University, Assiut, Egypt.
Exp Clin Transplant. 2024 Oct;22(10):794-799. doi: 10.6002/ect.2024.0213.
Portal inflow modulation is currently an essential step in living donor liver transplantation, particularly among patients with portal hypertension who receive small grafts. This study compared splenic artery ligation with splenectomy as a method for portal inflow modulation.
We compared 31 consecutive prospective adult patients who had splenic artery ligation during living donorlivertransplant with either right or left lobe donation performed from July 2021 to March 2024 with 22 consecutive retrospective patients who had splenectomy performed immediately before July 2021.
No differences were shown between splenic artery ligation and splenectomy groups in demographic data, indication, and Model for End-Stage Liver Disease score. Patients in the splenic artery ligation group had significantly smaller grafts than patients in the splenectomy group (graft-to-recipient weight ratio of 0.89 ± 0.23 vs 1.19 ± 0.24; P<.001) and less right lobes (41.9% [n=13] vs 90.9% [n=20]; P<.001).No significant differences between groups were shown for cold and warm ischemic times and estimated blood loss. Operative time was significantly shorter for patients in the splenic artery ligation versus splenectomy group (8.85 ± 1.33 vs 10.49 ± 0.75 h; P < .001). In the splenic artery ligation group, median portal vein pressure decreased from 19 (range, 16-23) to 14 (range, 11-20) mm Hg. In the splenectomy group, portal vein pressure decreased from 20.5 (range, 17-24) to 14.5 (range, 12-17) mm Hg. Both techniques showed no differences regarding effect on portal inflow modulation (P = .21). Incidence of small-for-size syndrome was not significantly different between groups.
Splenic artery ligation was not inferior to splenectomy as a method to perform portal inflow modulation to alleviate graft dysfunction in living donor liver transplant with portal hypertension.
门静脉流入调节目前是活体肝移植的重要步骤，特别是在接受小移植物的门静脉高压患者中。本研究比较了脾动脉结扎与脾切除术作为门静脉流入调节的方法。
我们比较了 2021 年 7 月至 2024 年 3 月期间进行的 31 例连续前瞻性成人患者，这些患者在活体供肝移植期间行脾动脉结扎术，供肝为右或左叶，与 2021 年 7 月前进行的 22 例连续回顾性患者行脾切除术进行比较。
脾动脉结扎组与脾切除术组在人口统计学数据、适应证和终末期肝病模型评分方面无差异。脾动脉结扎组患者的移植物明显小于脾切除术组（供体与受体体重比为 0.89±0.23 比 1.19±0.24；P<.001），右叶较少（41.9%[n=13]比 90.9%[n=20]；P<.001）。两组患者的冷缺血和热缺血时间以及估计失血量无显著差异。手术时间明显短于脾动脉结扎组（8.85±1.33 比 10.49±0.75 h；P<.001）。脾动脉结扎组门静脉压力中位数从 19（范围，16-23）降至 14（范围，11-20）mmHg。脾切除术组门静脉压力从 20.5（范围，17-24）降至 14.5（范围，12-17）mmHg。两种技术在门静脉流入调节效果方面没有差异（P=0.21）。小肝综合征的发生率在两组之间无显著差异。
脾动脉结扎与脾切除术一样，是门静脉高压活体肝移植中缓解移植物功能障碍的门静脉流入调节方法。
