Splenic Artery Syndrome as a Possible Cause of Late Onset Refractory Ascites After Liver Transplantation: Management With Proximal Splenic Artery Embolization

Pravisani, Riccardo; Baccarani, Umberto; Adani, Gian Luigi; Lorenzin, Dario; Vit, Alessandro; Cherchi, Vittorio; Calandra, Sergio; Rispoli, I.; Toniutto, Pierluigi; Sponza, Massimo; Risaliti, Andrea

doi:10.1016/j.transproceed.2016.01.013

Cited by 9 publications

(10 citation statements)

References 9 publications

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“…The prevalence of persistent ascites after DDLT has been found by other authors to vary from 3.4% to 7% [1][2][3]. That is significantly smaller than that found in studies evaluating living donor liver transplantation [LDLT; [11][12][13][14][15] which are largely accounted for by small for size grafts. We have found a greater percentage of this complication during the study period, which happened right after the change from chronological to gravity criteria.…”

Section: Discussionmentioning

confidence: 74%

“…In LDLT, small-for-size syndrome is associated with intractable ascites and can be treated with splenic artery ligation, splenectomy, or hemiportocaval shunt, to modulate portal inflow and to reduce flow in smaller grafts [12]. Some authors believe that an increased portal blood flow can also be the cause of refractory ascites after DDLT as well [13,14,16]. Troisi et al (1999) [16] performed 10 splenectomies in liver transplant patients, 3 of which indicated for massive ascitic fluid loss, based on the principle of reducing liver congestion due to excessive portal flow.…”

Section: Discussionmentioning

confidence: 99%

“…However, 4 patients had sepsis with a fatal outcome. Kim et al (2012) [14] and Pravisani et al (2016) [13] managed to avoid major complications performing splenic artery embolization's in more than 30 patients and they achieved a marked reduction in ascitic volume. Although partial splenectomy or splenic artery embolization can minimize the risk of sepsis, we did not find an increased spleen size in our patients with persistent ascites, compared to those without, that could justify such invasive procedures.…”

Section: Discussionmentioning

confidence: 99%

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Persistent Ascites after Orthotopic Liver Transplantation: Analysis of Predictive Factors

Mucenic¹,

Brandão²,

Marroni³

et al. 2018

J Liver

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Objective: Long-term persistence of ascites after orthotopic liver transplant can impact significantly on postoperative morbidity. Previous studies disclosed varied results in regard to prevalence, risk factors, ascitic fluid analysis and prognosis. The objective of the present study was to ascertain prevalence and risk factors in order to have a better understanding of this complication. Methods: All orthotopic liver transplantations performed for three consecutive years were considered for inclusion. The outcome was defined as ascites that was evident on clinical examination and/or required the use of diuretics for more than 90 days after surgery. Results: The main indications for transplant were decompensated cirrhosis and hepatocellular carcinoma. Ascites persisted in 19 (13.67%) out of 139 cases. Predictive factors were portosystemic encephalopathy, portal vein thrombosis, splenomegaly, creatinine level and volume of ascites drained during surgery. On multiple regression analysis, only the amount of ascites drained during transplantation (5.05 L × 1.58 L; p<0.008) and creatinine levels less than 12 hours before transplantation (2.39 mg/dL × 1.22 mg/dL; p=0.018) remained significantly related to ascites persistence. All biochemical analysis revealed increased serum-ascites albumin gradient. Death in the first year was similar in patients with or without ascites persistence (5.6 × 4.3%) Conclusion: This study evaluated multiple potential risk factors that could contribute to long-term persistence of ascites after liver transplantation. Loss of renal function and greater volume of ascites were significantly related to persistent ascites, which was a transudate with increased serum-ascites albumin gradient. Persistent ascites was not associated with increased mortality.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Persistent Ascites after Orthotopic Liver Transplantation: Analysis of Predictive Factors

Mucenic¹,

Brandão²,

Marroni³

et al. 2018

J Liver

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“…Therefore, if arterial flow to the spleen is decreased, venous return and portal circulation diminish. Thus, decreasing portal hyperflow and increasing adenosine release, which results in hepatic artery vasodilation and improved arterial flow (2). In this way, the problem is solved by targeting one of the links in the chain, i.e., by reducing splenic circulation with embolization.…”

Section: Discussionmentioning

confidence: 99%

“…The causes may be systemic (not associated with portal hypertension) or related to portal hypertension (prehepatic, hepatic and posthepatic) (2). Among the systemic causes, bacterial or fungal peritonitis (70%) and renal failure (6%) are the most significant.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Proximal Splenic Artery Embolization for Refractory Ascites and Hydrothorax Post-Liver Transplant

D’Amico

Partovi

Prete

et al. 2023

Cardiovasc Intervent Radiol

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Splenic Artery Syndrome as a Possible Cause of Late Onset Refractory Ascites After Liver Transplantation: Management With Proximal Splenic Artery Embolization

Cited by 9 publications

References 9 publications

Persistent Ascites after Orthotopic Liver Transplantation: Analysis of Predictive Factors

Persistent Ascites after Orthotopic Liver Transplantation: Analysis of Predictive Factors

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

Proximal Splenic Artery Embolization for Refractory Ascites and Hydrothorax Post-Liver Transplant

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