Reduction of Recipient Spleen Size after Living Donor Liver Transplantation: A Retrospective Study
Authors: Abdelghafar Mohamed Fathy , Emad Elsayed Mostafa Mahmoud , Mohamed Abozeid Mohamed Ahmed , Abdelhamid Mohamed Abdelsattar 
Published: July 2024

Abstract

Background
Liver transplantation is considered an important solution to patients with end stage liver disease and a glimpse of hope for some patients with terrible quality of life due to the morbidity of such disease. Living donor liver transplantation procedures has now become widely done worldwide and many studies have been done to improve its outcome and improve the quality of the patients’ lives.

Objective
to help identify the factors that affects the size of spleen after living donor liver transplantation and promotes the reduction in its size which greatly affects the patients’ and graft survival rate.

Patients and Methods
This is a retrospective study including patients underwent living donor liver transplantation to be conducted in Ain Shams university hospitals to determine the factors promoting reduction of spleen size after living donor liver transplantation. This study was conducted at Ain-Shams University Hospitals, in the period from January 2008 to June 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained.

Results
In our study we found that from 100 patients who had splenomegaly before transplantation, 54% of patients had persistent splenomegaly after liver transplantation, while 46% of patients had normal spleen size after transplantation within 1 year. The spleen size decreased significantly after transplantation in general, from a range of 13.3- 25 cm with a mean of 18.06 cm +/- 7 pre-op, to a range of 9-18 cm with a mean of 14.1 cm +/- 2.65. By analyzing this data and dividing it into two groups, it has been found that the group with persistent splenomegaly (54% of patients) had higher range of spleen size before transplantation with a range of 16.7-25 cm with a mean of 19.75 cm +/- 2.169, while the group of normal spleen size after transplantation ranged from 13.3-17 cm with a mean of 15.3 +/- 1.018 before transplantation. Also patients with dilated portal vein and portal vein thrombosis have higher chances of persistent splenomegaly post-operative. It has been found that in 93.4% of patients (43 patients)with reduced spleen size after transplantation had patent portal vein with average diameter, while only 6.5% (3 patients) had dilated portal vein and 0 patients with attenuated portal vein. On the other hand, 44.4% of patients with persistent splenomegaly had dilated portal vein, 38.9% had patent portal vein, and 16.67% had attenuated portal vein pre-op. Our study also showed the effect of spleen after transplantation on platelets levels and liver function. The normal spleen size was associated with better recovery of platelets number, in the group of patients with normal spleen size it ranged from 32 -189 10∧3/uL with a mean of 80 10∧3/uL pre-op, it increased to a mean of 163.95 10∧3/uL post op. While in the splenomegaly group the mean platelets count pre-op was 75.27 10∧3/uL in increased to 156.88 10∧3/uL post op. It has also been found that the decrease in spleen size greatly affects the liver functions, where in aspartate aminotransferase AST and Alanine transaminase ALT levels pre- operative in patients with normal spleen with a mean of 38.37 and 57.8 respectively. It decreased to a mean of 27 and 29.7 and difference of 11.2 and 28.1 respectively.

Conclusion
The spleen size after living donor liver transplantation is affected by the size of the spleen before transplantation and by the diameter portal vein before transplantation. Also the reduction in spleen size after living donor liver transplantation greatly affects the patient and graft survival platelets count and liver functions such as liver enzymes, albumin and coagulation profile.