Evaluation of prophylactic outcomes and clinical reliability on splenic artery banding for splenic artery steal syndrome in recipients after orthotopic liver transplantation
ZOU Weilong1, ZHANG Wei2, REN Xiuyun3, CHEN Xinguo1, SHEN Zhongyan1
1.Department of Liver Transplantation and Hepatopancreatobiliary Surgery, 2. Department of Laboratory Medicine, 3. Department of Ultrasound, General Hospital of Chinese People’s Armed Police Forces, Beijing 100039, China
Abstract：Objective To investigate the criteria of prophylaxis of splenic artery banding (SAB) on splenic artery steal syndrome (SASS), and to evaluate their clinical outcomes and reliability in recipients undergoing orthotopic liver transplantation (OLT). Methods 127 consecutive OLT recipients suffered from liver cirrhosis combined with splenomegaly. Ratio diameter of pre-OLT splenic artery(SA) to which of common hepatic artery (SA/CHA) ≥1.5 and intra-OLT peak systolic velocity (PSV)＜30 cm/s had been performed SAB in this hospital between January, 2004 and December, 2013. We reviewed their clinical data of clinical outcomes and safety. Results The sluggish and dim PSV of the patent hepatic artery increased immediately in the mean PSV from (19.34±5.45)cm/s to (45.89±9.13)cm/s (P<0.001), and resistivity index (RI) of HA rehabilitated to reasonable level (0.5-0.8) after intervention, without SASS or any artery-related complication detected. However, there were 17 cases SASS out of 191 patients exempted from SAB because of their intra-OLT PSV≥30 cm/s, and 11 cases of them secondary by HA thrombosis. Conclusions SASS is an important but often underdiagnosed cause of graft ischemia after OLT. Prophylactic SA banding deserves to be applied in patients risking on SASS for satisfactory results and reasonable safety.
Dokmak S, Aussilhou B, Belghiti J. Liver transplantation and splenic artery steal syndrome: the diagnosis should be established preoperatively [J]. Liver Transpl, 2013, 19(6): 667-668.
[2]
Nüssler N C, Settmacher U, Haase R, et al. Diagnosis and treatment of arterial steal syndromes in liver transplant recipients [J]. Liver Transpl, 2003, 9(6): 596-602.
[3]
Wojcicki M, Pakosz-Golanowska M, Lubikowski J, et al. Direct pressure measurement in the hepatic artery during liver transplantation: can it prevent the “steal” syndrome?[J]. Clin Transplant, 2012, 26(2): 223-228.
Grieser C, Denecke T, Steffen I G, et al. Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation[J]. Eur Radiol, 2010, 20(1): 108-117.
[6]
García-Criado A, Gilabert R, Bianchi L, et al. Impact of contrast-enhanced ultrasound in the study of hepatic artery hypoperfusion shortly after liver transplantation: contribution to the diagnosis of artery steal syndrome [J]. Eur Radiol, 2015, 25(1): 196-202.
[7]
Saad W E. Nonocclusive hepatic artery hypoperfusion syndrome (splenic steal syndrome) in liver transplant recipients [J]. Semin Intervent Radiol, 2012, 29(2): 140-146.
[8]
Uslu N, Aslan H, Tore H G, et al. Doppler ultrasonography findings of splenic arterial steal syndrome after liver transplant [J]. Exp Clin Transplant, 2012, 10(4): 363-367.
2015, Vol. 26 
