Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus

Am J Surg. 2015 Jan;209(1):180-6. doi: 10.1016/j.amjsurg.2014.03.004. Epub 2014 May 4.

Abstract

Background: Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated.

Methods: Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis.

Results: Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups.

Conclusion: Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT.

Keywords: Anti-viral therapy; Liver transplantation; Splenectomy; Splenectomy complication; Sustained viral response.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • Combined Modality Therapy
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / surgery*
  • Humans
  • Hypersplenism / surgery*
  • Hypersplenism / virology
  • Interferon alpha-2
  • Interferon-alpha / therapeutic use
  • Liver Cirrhosis / surgery*
  • Liver Cirrhosis / virology
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Polyethylene Glycols / therapeutic use
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Ribavirin / therapeutic use
  • Splenectomy*
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins
  • Polyethylene Glycols
  • Ribavirin
  • peginterferon alfa-2b
  • peginterferon alfa-2a