Role of splenectomy in human liver transplantation under modern-day immunosuppression

Between January 1987 and October 1991, 1466 patients underwent consecutive Orthotopic Liver Transplantation (OLTx) at the University of Pittsburgh. Forty of these patient's had concomitant splenectomy with OLTx. These patients were compared to 147 randomly selected OLTx patients without splenec...

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Bibliographic Details
Published in:Digestive diseases and sciences 1998-09, Vol.43 (9), p.1931-1937
Main Authors: SAMIMI, F, IRISH, W. D, EGHTESAD, B, DEMETRIS, A. J, STARZL, T. E, FUNG, J. J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Female
Graft Survival
Humans
Immunosuppressive Agents - therapeutic use
Incidence
Liver Transplantation - adverse effects
Liver Transplantation - mortality
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Risk
Sepsis - etiology
Sepsis - mortality
Splenectomy - adverse effects
Splenectomy - mortality
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival Analysis
Treatment Outcome
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Summary:Between January 1987 and October 1991, 1466 patients underwent consecutive Orthotopic Liver Transplantation (OLTx) at the University of Pittsburgh. Forty of these patient's had concomitant splenectomy with OLTx. These patients were compared to 147 randomly selected OLTx patients without splenectomy within the same time period. One-year patient and graft survival (PS and GS) were lower in splenectomized (Splx) patients compared to nonsplenectomized (non-Splx) patients (59% vs 86% PS, 55% vs 80% GS, respectively). One-month and one-year patient mortality in the Splx group was higher than in the non-splx patients (20% vs 3.4%, P < 0.001 for one month; 40% vs 14.3%, P = 0.003 for one year, respectively). One-month and one-year sepsis-related mortality was also high in Splx patients (17.5% vs 2.7%, P = 0.0022, for one month, and 30% vs 11.5%, P = 0.0043, for one year, respectively). We conclude that concomitant splenectomy with OLTx has a significantly higher patient mortality mainly due to its septic complications and, at present, unless there is a specific indication for a splenectomy, the routine addition of this procedure to liver allograft surgery would not be recommended.
ISSN:0163-2116
1573-2568
DOI:10.1023/a:1018822206580