Splenectomy improves graft survival after liver transplantation

Splenectomy may help prevent against small-for-size graft (SFSG) syndrome, boosting survival among living donor liver transplantation (LDLT) patients, a new study has found.

The researchers conducted a prospective, randomized study of 320 LDLT patients, of whom 258 underwent simultaneous splenectomy, while the remaining 62 did not. Propensity score matching was performed to minimize selection bias, leaving 50 participants in each group, matched in terms of demographic and donor variables, graft characteristics, and comorbidities.

SFSG developed in 32.3 percent of patients who had undergone splenectomy, and in 45.9 percent of those who had not (p=0.048). Early allograft dysfunction likewise occurred significantly less frequently among splenectomy patients (16.7 percent vs 29.3 percent; p=0.045).

The incidence of sepsis within 6 months after LDLT was also significantly lower among those who received simultaneous splenectomy (6.6 percent vs 14.8 percent; p=0.04), as were serum total bilirubin level (p<0.001) and prothrombin time-international normalized ratio (p<0.001) at postoperative day 14.

Nine patients in the nonsplenectomy group died within 3 months, as opposed to six who received the simultaneous procedure. The resulting mortality rates were significantly different in favour of splenectomy (14.5 percent vs 2.3 percent, respectively; p=0.001). Graft survival at 1, 3, and 5 years was also significantly better in the splenectomy group (p=0.007).

These findings remained statistically significant after propensity score matching. Univariate analysis in the matched cohorts also showed that absence of splenectomy was the only significant risk factor for graft loss after LDLT (hazard ratio, 3.06, 95 percent confidence interval, 1.07–11.0; p=0.037).