Korean J Pediatr Gastroenterol Nutr.  2004 Mar;7(1):92-97.

Successful Treatment with Partial Splenic Embolization in a Case of Post-transplantations Lymphoproliferative Disease with Persistent Hypersplenism

• Kim MJ
• Rho YI
• Yang ES
• Moon KR

Abstract

Posttranplantations lymphoproliferative disease (PTLD) is a common and life-threatening complication for soid organ transplantation associated with the use of chronic immunosuppression and Epstein-Barr virus. There is no standardized treatment algorithm, but numerous management strategies are vaiable. Partial splenic embolization (PSE) had been demonstrated to be an effetive alternatie to splenectomy for patients hypersplenism and portal hypertension. PSE has the advantages of non-invasive intervention and resolution of the complications of hypersplenism. We report the effect of the PSE in a 6-year old male liver transplantation recepient with PTLD who has undergone persistent hypersplenism post-transplant. We reduced immunosuppression agent, started antiviral agent. We started with interferon and IV globulin one month after admission. Hepatosplenomegaly and cervical lymphadenopathy were improved. But fever was not subside. We selectively embolized the lower pole of the spleen to achieve a 50~60% reduction in flow as determined by angiography. After embolization, fever subside and peripheral blood findings were improved. Follow up abdominal CT revealed reduced volume of spleen due to ischemic change and there was no multiple enlarged mesenteric lymphnode compared to preembolization state. We thick that PSE is a safe an effetive treatment modality of PTLD with persistent hypersplenism in patients twho failed to medical treatment.

Keyword

Partial splenic embolization (PSE); Posttranplantations lymphoproliferative disease (PTLD)

MeSH Terms

Angiography
Child
Fever
Follow-Up Studies
Herpesvirus 4, Human
Humans
Hypersplenism*
Hypertension, Portal
Immunosuppression
Interferons
Liver Transplantation
Lymphatic Diseases
Male
Organ Transplantation
Spleen
Splenectomy
Tomography, X-Ray Computed
Transplants
Interferons