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Effect of Liver Transplantation on Spleen Size, Collateral Veins, and Platelet Counts

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Abstract

Background

The aim of this study was to evaluate the effect of liver transplantation on the spleen size, spontaneous splenorenal shunt (SRS) function, and platelet counts in patients with hypersplenism.

Methods

Between December 2001 and February 2007, 462 adult patients underwent orthotopic liver transplantations (OLTX) at our institution. Of these patients, CT or MRI information was reviewed retrospectively in 55 patients. Volume measurements of the spleen and liver, spleen/liver volume ratio (S/L ratio), presence and size of SRS, and platelet counts were evaluated before and after OLTX.

Results

Mean spleen volume decreased from 827 ± 463 ml to 662 ± 376 ml after OLTX (p < 0.01). Five (11%) patients returned to normal-range spleen size after OLTX. SRS was observed in 19 patients before OLTX (35%). The diameter of SRS also significantly decreased from 1.0 ± 0.5 cm before OLTX to 0.7 ± 0.5 cm after OLTX (p < 0.05). SRS disappeared in 16% of patients (3/19). S/L ratio significantly decreased from 0.65 ± 0.33 to 0.38 ± 0.17 (p < 0.01) after OLTX. Platelet counts significantly increased after OLTX (p < 0.01). Improvement of the platelet count in the group with postoperative S/L ratio >0.35 was not as good as that in the group with S/L ratio <0.35 (p < 0.01).

Conclusions

Spleen size and SRS size became significantly smaller after OLTX. However, patients with postoperative S/L ratio >0.35 tend to have lower platelet counts after OLTX.

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Abbreviations

OLTX:

Orthotopic liver transplantation

SRS:

Splenorenal shunt

S/L ratio:

Spleen/liver volume ratio

CT:

Computed tomography

MRI:

Magnetic resonance imaging

INR:

International normalized ratio

EGV:

Esophagogastric varices

PEV:

Paraesophageal veins

SLV:

Recipient’s standard liver volume

RLV:

Recipient’s natural liver volume

BSA:

Body surface area

RR-SV:

Reversal rate of the splenic volume

RR-S/L:

Reversal rate of the S/L ratio

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Acknowledgment

The authors thank Ms. Mary Murtha, Department of Surgery, University of Miami, for her contribution in collecting the data.

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Correspondence to Fumio Chikamori.

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Chikamori, F., Nishida, S., Selvaggi, G. et al. Effect of Liver Transplantation on Spleen Size, Collateral Veins, and Platelet Counts. World J Surg 34, 320–326 (2010). https://doi.org/10.1007/s00268-009-0314-x

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  • DOI: https://doi.org/10.1007/s00268-009-0314-x

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