The Effect of Splenectomy on the Reversal of Cirrhosis: a Prospective Study

Zeng, Daobing; Liang, Dan; Zhang, Rui-chi; Guo, Qingliang; Duan, Binwei; Jia, Cui-Yu; Chen, Feng; Lin, Dongdong; Zang, Yunjin; Lu, Shichun

doi:10.1155/2019/5459427

Cited by 9 publications

(5 citation statements)

References 48 publications

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“…Tanabe et al demonstrated that the migration of Th2dominant splenic lymphocytes induces liver fibrosis by shifting the cytokine balance toward Th2 dominance [41]. Plenty of human studies also showed potential and significant effect of splenectomy in respect to the reversal of cirrhosis [42][43][44]. At one-year follow-up after splenectomy, Yamamoto at al.…”

Section: Discussionmentioning

confidence: 99%

Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis ‐ a retrospective study

et al. 2020

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The risk factors and clinical impact of post-transplantation splenomegaly (SM) are poorly understood. We investigated the predictors and impacts of post-transplantation SM in 415 LT patients at Kyoto University Hospital from April 2006 to December 2015. First, the predictors and clinical consequences of SM three years post-transplantation were analyzed among spleen-preserved recipients. Second, the clinical data of surviving recipients three years post-transplantation were compared between splenectomized and spleen-preserved recipients. There was no difference in indication for liver transplantation between these two groups. Third, survival outcomes were compared between splenectomized and spleen-preserved recipients. SM was determined as a SV/body surface area (BSA) higher than 152 ml/ m 2. In the first analysis, preoperative SM occurred in 79.9% recipients and SM persisted three years post-transplantation in 72.6% recipients among them. Preoperative SV/BSA was the only independent predictor of three year post-transplantation SM, which was associated with lower platelet (PLT), white blood cell (WBC) counts and significant graft fibrosis (21.4% vs. 2.8%). In the second analysis, spleen-preservation was related to lower PLT, WBC counts and a higher proportion of significant graft fibrosis (26.7% vs. 7.1%) three years post-transplantation. In the third analysis, spleen-preserved recipients showed worse survival than splenectomized recipients. In conclusion, preoperative SM frequently persists more than three years post-transplantation and is associated with subclinical hypersplenism, graft fibrosis, graft loss, and even death.

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Section: Discussionmentioning

confidence: 99%

Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis ‐ a retrospective study

et al. 2020

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“…Microstructural-level animal experiments further demonstrated that splenectomy could effectively alleviate liver brosis in cirrhotic mice [19]. Additionally, Zeng et al reported that splenectomy could signi cantly decrease serum brosis indicators among patients with cirrhosis [20]. Various pathophysiological mechanisms may be involved in this process, wherein splenectomy plays a crucial role.…”

Section: Discussionmentioning

confidence: 99%

The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization

Zhang,

Wang,

Chen

et al. 2024

Preprint

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Background Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. In addition, whether HVPG could provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. Methods From January 2016 to March 2023, 134 patients with PHT underwent LSED at our hospital were retrospectively evaluated. The correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB) were analyzed. Among them, 57 patients remeasured postoperative HVPG. Postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB, were further investigated. Results In this study, we found that 93 patients with preoperative UGIB (16.27 ± 5.73mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90mmHg) (P = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, P = 0.001) than baseline, 66% of patients (38/57) experienced the decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response. Additionally, the patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, P = 0.013). Conclusion We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without.

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“…It has been found that splenectomy effectively decreases portal pressure and corrects hypersplenism in patients with cirrhosis[ 83 , 84 ]. Since the progression of cirrhosis may result in a parallel increase in portal pressure, it would be worth investigating whether a reduction in portal pressure, after splenectomy, contributes to decreased lymph formation and decreased overload of the lymphatic system.…”

Section: Therapeutic Perspectivementioning

confidence: 99%

Lymphatic dysfunction in advanced cirrhosis: Contextual perspective and clinical implications

Kumar¹,

Anand²,

Priyadarshi³

2021

WJH

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The lymphatic system plays a very important role in body fluid homeostasis, adaptive immunity, and the transportation of lipid and waste products. In patients with liver cirrhosis, capillary filtration markedly increases, primarily due to a rise in hydrostatic pressure, leading to enhanced production of lymph. Initially, lymphatic vasculature expansion helps to prevent fluid from accumulating by returning it back to the systemic circulation. However, the lymphatic functions become compromised with the progression of cirrhosis and, consequently, the lymphatic compensatory mechanism gets overwhelmed, contributing to the development and eventual worsening of ascites and edema. Neurohormonal changes, low-grade chronic inflammation, and compounding effects of predisposing factors such as old age, obesity, and metabolic syndrome appear to play a significant role in the lymphatic dysfunction of cirrhosis. Sustained portal hypertension can contribute to the development of intestinal lymphangiectasia, which may rupture into the intestinal lumen, resulting in the loss of protein, chylomicrons, and lymphocyte, with many clinical consequences. Rarely, due to high pressure, the rupture of the subserosal lymphatics into the abdomen results in the formation of chylous ascites. Despite being highly significant, lymphatic dysfunctions in cirrhosis have largely been ignored; its mechanistic pathogenesis and clinical implications have not been studied in depth. No recommendation exists for the diagnostic evaluation and therapeutic strategies, with respect to lymphatic dysfunction in patients with cirrhosis. This article discusses the perspectives and clinical implications, and provides insights into the management strategies for lymphatic dysfunction in patients with cirrhosis.

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The Effect of Splenectomy on the Reversal of Cirrhosis: a Prospective Study

Cited by 9 publications

References 48 publications

Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis ‐ a retrospective study

Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis ‐ a retrospective study

The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization

Lymphatic dysfunction in advanced cirrhosis: Contextual perspective and clinical implications

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