The role of splenectomy before liver transplantation in biliary atresia patients

Takahashi, Yoshiaki; Matsuura, Toshiharu; Yanagi, Yusuke; Yoshimaru, Koichiro; Taguchi, Tomoaki

doi:10.1016/j.jpedsurg.2016.09.048

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Regarding the other secondary lymphoid tissue, maternal microchimeric stem cells may reside in the spleen. Takahashi et al (41) reported that splenectomy for livertransplant candidates improved liver function, avoiding liver transplantation in 50% of patients during a mean follow-up period of 56 months. This observation may support the theory that maternal memory T cells may retain in the spleen and Even after bile drainage is achieved with KPE and immune imbalance may be reversed with corticosteroids, persistent maternal chimeric cells may continue to skew immunity toward autoreactivity, causing a flare-up of inflammation, leading to frequent episodes of cholangitis and ongoing liver fibrosis.…”

Section: Two-hit Model For Etiopathogenesis: Perinatal Transition Fro...mentioning

confidence: 99%

New insights in understanding biliary atresia from the perspectives on maternal microchimerism

et al. 2022

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Biliary atresia (BA) is a fibroinflammatory cholangiopathy and portal venopathy. It is of unknown etiology and is associated with systemic immune dysregulation, in which the first insult begins before birth. Maternal microchimerism is a naturally occurring phenomenon during fetal life in which maternal alloantigens promote the development of tolerogenic fetal regulatory T-cells in utero. However, maternal cells may alter the fetus’s response to self-antigens and trigger an autoimmune response under certain histocompatibility combinations between the mother and the fetus. A recent report on a set of dizygotic discordant twins with BA, one of whose placentae showed villitis of unknown etiology, implies a certain immune-mediated conflict between the fetus with BA and the mother. Maternal chimeric cells persist postnatally for various time spans and can cause cholangitis, which ultimately leads to liver failure. In contrast, patients who eliminate maternal chimeric cells may retain their liver function.

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Section: Two-hit Model For Etiopathogenesis: Perinatal Transition Fro...mentioning

confidence: 99%

New insights in understanding biliary atresia from the perspectives on maternal microchimerism

et al. 2022

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“…The Centers for Disease Control and Prevention recommend that patients before splenectomy receive the 23‐valent pneumococcal vaccine to prevent OPSI, as this covers approximately 73–90% of strains causing OPSI . In our previous study, administering the 23‐valent pneumococcal vaccine before splenectomy and the oral administration of penicillin was sufficient to prevent OPSI .…”

Section: Discussionmentioning

confidence: 85%

Liver graft-to-spleen volume ratio as a useful predictive factor of the early graft function in children and young adults transplanted for biliary atresia: a retrospective study

et al. 2018

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A graft volume/standard liver volume ratio (GV/SLV) > 35% or graft/recipient weight ratio (GRWR) > 0.8% has been considered as a standard criteria of graft selection. Even if the graft size meets these selection criteria, small-for-size syndrome can still occur depending on the portal venous flow (PVF). The aim of this study was to identify other factors contributing to portal hyperperfusion and the post-transplant course, focusing on the graft volume-to-spleen volume ratio (GV/SV). Thirty-seven BA patients who underwent living donor liver transplantation were reviewed retrospectively. First, we evaluated the preoperative factors contributing to portal hyperperfusion. Second, we evaluated the factors contributing to post-transplant complications, such as thrombocytopenia, hyperbilirubinemia, and coagulopathy. The GV/SLV was >35% in all cases; however, portal hyperperfusion (≥250 ml/min/100 g graft) was found in 12 recipients (35.3%). Furthermore, although the GRWR was >0.8% in over 90% of cases, portal hyperperfusion was found in 10 recipients (32.3%). In contrast, the GV/SV showed a significant correlation with the PVF after reperfusion. If the GV/SV was <0.88, about 80% of recipients developed portal hyperperfusion. Furthermore, the GV/SV also showed a significant correlation with post-transplant persistent thrombocytopenia and hyperbilirubinemia. The GV/SV < 0.88 predicts portal hyperperfusion, post-transplant persistent thrombocytopenia, and hyperbilirubinemia.

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“…Finally, splenectomy is also effective in improving hypersplenism in patients with cirrhosis. Takahashi et al [ 35 ] reported that in ten patients with biliary atresia combined with hypersplenism who underwent splenectomy prior to liver transplantation, the patients' hematocrit recovered to normal levels 1 mo after surgery, and the mean Model for End-stage Liver Disease (MELD) score improved significantly.…”

Section: Discussionmentioning

confidence: 99%

Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

Qi,

Wen,

Wen

et al. 2023

World J Gastrointest Surg

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Tumour rupture of gastrointestinal stromal tumours (GISTs) has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome. Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor, it may change the natural history of a low-risk GIST to a high-risk GIST. Originally, tumour rupture was defined as the spillage or fracture of a tumour into a body cavity, but recently, new definitions have been proposed. These definitions distinguished from the prognostic point of view between the major defects of tumour integrity, which are considered tumour rupture, and the minor defects of tumour integrity, which are not considered tumour rupture. Moreover, it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture. Therefore, after excluding tumour rupture, R1 may not be an unfavourable prognostic factor for GISTs. Additionally, after the standard adjuvant treatment of imatinib for GIST with rupture, a high recurrence rate persists. This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.

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The role of splenectomy before liver transplantation in biliary atresia patients

Cited by 8 publications

References 13 publications

New insights in understanding biliary atresia from the perspectives on maternal microchimerism

New insights in understanding biliary atresia from the perspectives on maternal microchimerism

Liver graft-to-spleen volume ratio as a useful predictive factor of the early graft function in children and young adults transplanted for biliary atresia: a retrospective study

Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

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