Yazici Sinan Efe, Atasever Ahmet, Yuzer Yildiray
Department of Liver Transplantation, Faculty of Medicine, Demiroğlu Bilim University, Istanbul, Turkey.
Department of Liver Transplantation, Florence Nightingale Hospital Liver Transplantation Center, Istanbul, Turkey.
Ann Transplant. 2025 May 6;30:e947760. doi: 10.12659/AOT.947760.
BACKGROUND Living donor liver transplantation (LDLT) has been shown to be safe in the curative treatment of liver cirrhosis. Portal flow modulation techniques, such as splenic artery ligation (SAL), have been used to avoid complications like small-for-size syndrome (SFSS). However, the effects of SAL on portal flow, splenic function, and hematologic outcomes remain underexplored. MATERIAL AND METHODS This retrospective study analyzed 60 LDLT recipients treated at a single center from January 2023 to December 2024. Thirty patients underwent SAL (SAL+) while 30 did not undergo SAL (SAL-). Data on demographic and clinical characteristics, portal flow dynamics, spleen volume, hematologic parameters, and postoperative complications were collected and analyzed using IBM SPSS 20.0. Statistical significance was set at P<0.05. RESULTS SAL significantly reduced portal flow from 3148±989 mL/min to 1949±830 mL/min (P<0.001), optimizing the portal flow/graft weight ratio. SAL also decreased splenic volume by 21% and alleviated thrombocytopenia, with postoperative platelet counts increasing 3.8-fold compared to preoperative levels (P<0.001). There were fewer complications in the SAL+ group, with significant reductions in biliary complications and improved graft function. No severe ischemic splenic changes or thromboembolic events were observed in the SAL+ group. CONCLUSIONS SAL is an effective strategy for portal flow modulation in LDLT, significantly reducing portal flow to optimal levels and improving hematologic outcomes. By preserving splenic function and minimizing complications, SAL is a safe and beneficial approach to managing SFSS and improving graft performance in LDLT patients.
背景 活体肝移植（LDLT）已被证明在肝硬化的根治性治疗中是安全的。门静脉血流调节技术，如脾动脉结扎术（SAL），已被用于避免诸如小肝综合征（SFSS）等并发症。然而，SAL对门静脉血流、脾功能和血液学结果的影响仍未得到充分研究。
材料与方法 这项回顾性研究分析了2023年1月至2024年12月在单一中心接受治疗的60例LDLT受者。30例患者接受了SAL（SAL+组），而30例未接受SAL（SAL-组）。收集了人口统计学和临床特征、门静脉血流动力学、脾脏体积、血液学参数和术后并发症的数据，并使用IBM SPSS 20.0进行分析。统计学显著性设定为P<0.05。
结果 SAL显著降低门静脉血流，从3148±989 mL/分钟降至1949±830 mL/分钟（P<0.001），优化了门静脉血流/移植物重量比。SAL还使脾脏体积减少了21%，并缓解了血小板减少症，术后血小板计数与术前水平相比增加了3.8倍（P<0.001）。SAL+组的并发症较少，胆道并发症显著减少，移植物功能改善。SAL+组未观察到严重的脾脏缺血性改变或血栓栓塞事件。
结论 SAL是LDLT中门静脉血流调节的有效策略，可显著将门静脉血流降至最佳水平并改善血液学结果。通过保留脾功能并将并发症降至最低，SAL是管理LDLT患者的SFSS和改善移植物性能的安全有益方法。
