Splenic Artery Syndrome as a Possible Cause of Late Onset Refractory Ascites After Liver Transplantation: Management With Proximal Splenic Artery Embolization

Abstract Background Portal hyperperfusion (PHP) is a hemodynamic condition which may develop after liver transplantation and cause refractory ascites (RA). The diagnosis is established by exclusion of other causes of increased sinusoidal pressure/resistance such as cellular rejection or toxicity and...

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Bibliographic Details
Published in:Transplantation proceedings 2016-03, Vol.48 (2), p.377-379
Main Authors: Pravisani, R, Baccarani, U, Adani, G, Lorenzin, D, Vit, A, Cherchi, V, Calandra, S, Rispoli, I, Toniutto, P, Sponza, M, Risaliti, A
Format: Article
Language:English
Subjects:
Aged
Ascites - epidemiology
Ascites - etiology
Ascites - physiopathology
Ascites - therapy
Blood Flow Velocity
Cohort Studies
Disease Management
Embolization, Therapeutic - methods
Female
Hemodynamics
Hepatic Artery
Humans
Liver
Liver Circulation - physiology
Liver Transplantation
Male
Middle Aged
Portal Pressure
Portal System - physiopathology
Portal Vein
Postoperative Complications - epidemiology
Postoperative Complications - physiopathology
Postoperative Complications - therapy
Retrospective Studies
Spleen
Splenic Artery
Surgery
Syndrome
Vascular Diseases - complications
Vascular Diseases - epidemiology
Vascular Diseases - physiopathology
Vascular Diseases - therapy
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Summary:Abstract Background Portal hyperperfusion (PHP) is a hemodynamic condition which may develop after liver transplantation and cause refractory ascites (RA). The diagnosis is established by exclusion of other causes of increased sinusoidal pressure/resistance such as cellular rejection or toxicity and outflow obstruction. PHP as part of the pathogenesis of the splenic artery syndrome (SAS) can be treated with splenic artery embolization (SAE). Methods This is a retrospective study on a cohort of first-time whole-size liver transplant recipients diagnosed with RA due to PHP and treated by proximal SAE (pSAE) at the Liver Transplant Unit of the University Hospital of Udine between 2004 and 2014. Results For this study, 23 patients were identified (prevalence 8%) and treated. Preliminary clinical workup to diagnose SAS was based on exclusion of other possible causes of RA with graft biopsy, cavogram with hepatic venous pressure measurement, computed tomography scan, and angiography. The pSAE was performed 110 ± 61 days after transplantation, and no procedure-related complications occurred. pSAE resulted in a significant decrease of portal vein velocity ( P  = .01) and wedge hepatic venous pressure ( P  = .03). The diameter of the spleen showed a slightly significant reduction ( P  = .047); no modification of hepatic artery resistive index were encountered ( P  = .34). Moreover, pSAE determined the resolution of RA in all cases. Conclusions pSAE is a safe and effective procedure to modulate the hepatic inflow and thus to treat RA secondary to SAS, with a low incidence of complications and a high rate of clinical response.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2016.01.013