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The role of splenectomy before liver transplantation in biliary atresia patients.

Abstract：

BACKGROUND/PURPOSE:There is currently no unified view regarding whether liver transplantation or splenectomy should be performed for hypersplenism before liver transplantation in biliary atresia (BA) patients. We herein describe the efficacy of splenectomy before liver transplantation. METHODS:Splenectomy was performed in ten patients with hypersplenism associated with BA. We retrospectively reviewed their perioperative and postoperative courses, the number of leukocytes and thrombocytes, and the MELD score. RESULTS:The mean age was 17.5±7.0years (range 11-31years), and the male-to-female ratio was 1:1. The platelet and leukocyte levels increased after splenectomy and returned to normal levels one month postoperatively. The mean MELD score after splenectomy was significantly decreased after splenectomy: 10±2.1 vs 7.6±1.8. In particular, PT-INR improved. Five patients underwent liver transplantation because of hepatopulmonary syndrome and repeated bouts of cholangitis, whereas the remaining five patients did not undergo liver transplantation because of improvements in the liver function (the mean follow-up period was 56months). The postoperative complications included portal vein thrombosis and intestinal perforation, but the patient survival rates remained at 100%. CONCLUSION:After splenectomy, both pancytopenia and the liver function clearly improved. Splenectomy should therefore be a treatment option for patients with hypersplenism before liver transplantation. LEVEL OF EVIDENCE:Retrospective Comparative Study - Level III.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Takahashi Y,Matsuura T,Yanagi Y,Yoshimaru K,Taguchi T

doi

10.1016/j.jpedsurg.2016.09.048

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

2095-2098

issue

12

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(16)30371-2

journal_volume

51

pub_type

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