Simultaneous splenectomy improves outcomes after adult livin
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Small-for-size graft (SFSG) syndrome is a major cause of graft loss after living donor liver transplantation (LDLT). Researchers have found that simultaneous splenectomy can be used to overcome small-for-size graft syndrome. They also found that simultaneous splenectomy improved clinical outcomes in LDLT recipients after propensity-score matching.

In a research published by the Journal of Hepatology, researchers aimed to elucidate the effect of simultaneous Splenectomy (Spx) on graft function and long-term outcomes after LDLT.

325 patients were divided into 2 groups: those undergoing (n = 258) and those not undergoing (n = 62) simultaneous Spx. To overcome selection bias, propensity score matching (PSM) was performed. Findings were;

--Before PSM, recipients undergoing simultaneous Spx showed better graft function on post-operative day (POD) 7 and 14, as well as lower sepsis frequency within 6 months after LDLT and better graft survival rates compared to those not undergoing Spx.

--After PSM, compared to patients not undergoing Spx, those undergoing Spx had a lower frequency of early graft dysfunction on POD 7; a lower frequency of SFSG syndrome, lower serum total bilirubin levels, and lower international normalized ratio on POD 14; lower sepsis frequency within 6 months after LDLT, and better graft survival rates.

--Univariate analysis revealed that not undergoing Spx was the only risk factor for graft loss after LDLT.

Conclusively, simultaneous Spx may prevent SFSG syndrome and is a predictive factor for graft survival after LDLT. Simultaneous Spx is recommended when a small graft is predicted preoperatively, or for patients with portal hypertension or high portal pressure after reperfusion in LDLT.

Source: https://doi.org/10.1016/j.jhep.2020.08.017
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