Partial splenic embolization for portal hypertension before and after living donor liver transplantation

概要

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Partial splenic artery embolization (PSE) has been widely used in the treatment of pancytopenia and esophagogastric varices in patients with portal hypertension. We compared the effect of PSE performed before living donor liver transplantation (LDLT) with that performed after LDLT. The spleen volume reduced to 44.1% of pretreatment volume after LDLT in the preoperative PSE group, and to 42.3% in the postoperative PSE group. The ratio of platelet count (the one measured 1 year after PSE + LDLT/that measured before PSE + LDLT)was increased to 3.20 in preoperative PSE group. While, it was had increased only to 1.58 in the postoperative group. In patients with portsystemic shunts, preoperative PSE was supposed to prevent steal of graft's portal blood flow. LDLT with additional PSE appears more effective in the treatment of persistent hypersplenism than LDLT alone. Especially, preoperative PSE seems useful in LDLT of small-for-size graft with portsystemic shunts.