Clinical Trials Study
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World J Gastroenterol. Nov 7, 2014; 20(41): 15367-15373
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15367
New strategies for prevention and treatment of splenic artery steal syndrome after liver transplantation
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309th Hospital of Chinese People’s Liberation Army, Beijing 100091, China
Author contributions: Song JY and Du GS designed the study; Song JY, Shi BY, Du GS, Zhu ZD and Zheng DH performed the operations; Feng LK and Zhou L collected the data; Song JY, Li G and Wu TT analyzed the data; Song JY wrote the paper; all authors read and approved the final manuscript.
Correspondence to: Guo-Sheng Du, Professor, Organ Transplant Institute, the 309th Hospital of Chinese People’s Liberation Army, No. 17 Heishanhu Road, Haidian District, Beijing 100091, China. duguosheng@medmail.com
Telephone: +86-10-66775208 Fax: +86-10-66775208
Received: March 1, 2014
Revised: May 5, 2014
Accepted: July 22, 2014
Published online: November 7, 2014
Processing time: 253 Days and 23.1 Hours
Abstract

AIM: To explore a prophylactic procedure to prevent splenic artery steal syndrome (SASS), as well as a therapeutic intervention to correct it.

METHODS: Forty-three liver transplant patients were enrolled in a non-randomized controlled trial, with the eligible criterion that the diameter of the splenic artery is more than 5 mm and/or 1.5 times of the diameter of the hepatic artery. The procedure of splenic artery banding was performed in 28 of the 43 patients, with the other 15 patients studied as a control group. SASS and other complications were compared between these two groups. A new therapeutic intervention, temporary incomplete blockade of the splenic artery with a balloon, was performed to treat SASS in this study.

RESULTS: The incidence of SASS was decreased by banding the splenic artery (0/28 vs 5/15, P = 0.006), and the same result was observed in total complications associated with prophylactic procedures (2/28 vs 6/15, P = 0.014). Five patients in the control group developed SASS within 5 d after OLT, 2 of whom were treated by coil embolization of the splenic artery, whereas the other 3 by temporary blockade of the splenic artery. Reappeared or better hepatic arteries with improved systolic amplitude and increased diastolic flow were detected by Doppler ultrasonography in all the 5 patients. Local splenic ischemic necrosis and nonanastomotic biliary stricture were diagnosed respectively in one patient treated by coil embolization, and no collateral complication was detected in patients treated by temporary blockade of the splenic artery.

CONCLUSION: SASS should be avoided during the operation by banding the splenic artery. Temporary blockade of the splenic artery is a new safe and effective intervention for SASS.

Keywords: Organ transplantation; Liver transplantation; Splenic artery steal syndrome; Vascular complication; Angiography

Core tip: Splenic artery steal syndrome (SASS) is a rare but severe vascular complication after orthotopic liver transplantation (OLT). Splenic artery embolization has been reported to treat SASS, which could induce local ischemic necrosis of the spleen, infection and septicemia. We proved that banding the proximal splenic artery, whose diameter exceeds 5 mm and/or 1.5 times of the diameter of the hepatic artery, during the OLT was an effective preventive intervention. We also recommend occluding the splenic artery temporarily as a new therapeutic intervention, by which, the possible complications of splenic artery embolization could be avoided.