Korean J Transplant.  2022 Nov;36(Supple 1):S51. 10.4285/ATW2022.F-1672.

Successful management of splenic artery steal syndrome after living donor liver transplantation by splenic artery embolization

Affiliations
  • 1Department of Hepatobiliary and Pancreatic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea

Abstract

Splenic artery steal syndrome (SASS) is rarely diagnosed syndrome in patients who received liver transplantation with 0.6%– 10.1% incidence. The mechanism of SASS is not clarified but there is a hypothesis that portal hypertension cause hepatic artery buffer response and then HA hypoperfusion. SASS can be diagnosed with Doppler ultrasonography (DUS), computed tomography (CT) and angiography but reliable diagnostic criteria is not defined yet. And splenectomy, splenic artery ligation or embolization are used for treatment of SASS. The patient was a 60-year-old female and has liver cirrhosis due to hepatitis B virus. Preoperative CT showed splenomegaly, large splenorenal shunt, small portal vein with enlarged splenic artery and paraesophageal varix. She received living donor liver transplantation (LDLT) from her son. Right lobe graft was donated and graft-re-cipient weight ratio (GRWR) was 0.92. Small V5 was ligated and there was no V8. Duct-to-duct anastomosis with internal stent insertion was done and recipients left renal vein was ligated. After LDLT, acute rejection was suspicious with abnormal lab findings. However, liver biopsy showed no evidence of rejection. Under suspicion of portal theft syndrome, splenic coronary embolization was performed, but an emergency exploratory laparotomy was performed due to bleeding. After operation, there were still abnormal and not-recovered lab findings. However, postoperative CT showed preserved blood flow in HA, PV, HV, but interval increased size of spleen. Immediately, splenic artery embolization was performed. After embolization, lab finding was rapidly recovered and finally, the patient could discharge. SASS is hard to diagnose and can lead to graft failure. Suspicion for SASS is very important, but DUS is hard to detect SASS in some cases. Angiography can be gold standard for diagnostic tool. Percutaneous splenic artery embolization is a safe and effective method for the treatment of SASS.

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