Complete splenic embolization for the treatment of refractory ascites after liver transplantation

Abstract

Refractory ascites is an uncommon complication that may develop postoperatively after liver transplantation. The diagnosis and treatment of this condition is a real challenge. We report two cases of patients who underwent a transplant due to cryptogenic cirrhosis and developed refractory ascites during the immediate postoperative period. This is a serious complication associated with decreased survival by up to one year and a reduced quality of life. After ruling out the main causes of ascites, a portal hyperflow was a potential etiology. This condition perpetuates itself with splenic circulation and brings about a reduction in the hepatic arterial flow. Therefore, if arterial blood flow to the spleen is diminished, venous return and portal circulation will be reduced and arterial blood flow will improve. Splenic artery embolization is a procedure introduced many years ago for the management of splenic artery steal syndrome and small-for-size living donor liver transplantation. This procedure is performed in order to reduce portal hyperflow and consequently, ascites. In conclusion, splenic artery embolization is a therapeutic option for the treatment of refractory ascites after liver transplantation.

Efficacy and safety of splenic artery embolization for intractable ascites using Amplatzer vascular plug versus coil after living donor liver transplantation

“…This is particularly important in high-flow vessels where there is risk of distal migration of coils. 13,21 A previous systematic review and metaanalysis 23 revealed that distal embolization at small arterial branches within the splenic parenchyma may lead to splenic infarction or increase the risk of splenic abscess formation. Proximal embolization at the main splenic artery may decrease the risk of infarction because the rich network of collateral circulation from the left gastric, gastroepiploic arteries, pancreatic, and omental branches enters the spleen.…”

“…7,8 Several studies have investigated SAE as the treatment of IA after liver transplantation. 5,7,8,10,13 However, the choices of different embolic materials used in SAE still need to be discussed. Even though SAE using AVP and coils has been described, 12 the therapeutic efficacy and outcomes between AVP and coils for patients with IA after livingdonor liver transplantation (LDLT) have not been established.…”

Feasibility of using marginal liver grafts in living donor liver transplantation

“…Graft inflow or PVP modulation is at the forefront of these treatments. Portosystemic shunting techniques or preservation of collateral veins[ 19 , 47 - 50 ], as well as splenectomy or splenic artery ligation/embolization[ 51 - 53 ], are effective ways to address post-transplantation portal hyperperfusion. In cases where the GRWR of grafts is very low, dual grafts can be considered[ 54 ].…”