Abstract：
BACKGROUND: The consensus that portal venous pressure modulation, including splenectomy (Spx), prevents portal hypertension-related complications after living-donor liver transplantation (LDLT) has been established. However, little evidence about the risk factors for graft loss after simultaneous Spx during LDLT is available. This study aimed to identify the independent predictors of graft loss after simultaneous Spx during LDLT.
METHODS: Data of 655 recipients who underwent LDLT between 1997 and 2021 were collected and separated into the simultaneous Spx group (n = 461) and no-Spx group (n = 194).
RESULTS: The simultaneous Spx group had significantly lower serum total bilirubin levels, drained ascites volumes, and prothrombin time-international normalized ratios on postoperative day 14 than the no-Spx group ( P < 0.001 for each). Incidences of small-for-size graft syndrome ( P < 0.001), acute cellular rejection ( P = 0.002), and sepsis ( P = 0.007) were significantly lower in the Spx group. Graft survival of the Spx group was significantly better than that of the no-Spx group ( P < 0.001; hazard ratio [HR], 1.788; 95% confidence interval, 1.214-2.431). A multivariate analysis revealed that 3 variables, platelet count ≤4.0 × 10 4 /mm 3 ( P = 0.029; HR, 2.873), donor age ≥60 y old ( P = 0.013; HR, 6.693), and portal venous pressure at closure ≥20 mm Hg ( P = 0.010; HR, 3.891), were independent predictors of graft loss within 6 mo after simultaneous Spx during LDLT.
CONCLUSIONS: Spx is a safe inflow modulation procedure with a positive impact on both postoperative complications and prognosis for most patients. However, patients with the 3 aforementioned independent factors could experience graft loss after LDLT.
METHODS: Data of 655 recipients who underwent LDLT between 1997 and 2021 were collected and separated into the simultaneous Spx group (n = 461) and no-Spx group (n = 194).
RESULTS: The simultaneous Spx group had significantly lower serum total bilirubin levels, drained ascites volumes, and prothrombin time-international normalized ratios on postoperative day 14 than the no-Spx group ( P < 0.001 for each). Incidences of small-for-size graft syndrome ( P < 0.001), acute cellular rejection ( P = 0.002), and sepsis ( P = 0.007) were significantly lower in the Spx group. Graft survival of the Spx group was significantly better than that of the no-Spx group ( P < 0.001; hazard ratio [HR], 1.788; 95% confidence interval, 1.214-2.431). A multivariate analysis revealed that 3 variables, platelet count ≤4.0 × 10 4 /mm 3 ( P = 0.029; HR, 2.873), donor age ≥60 y old ( P = 0.013; HR, 6.693), and portal venous pressure at closure ≥20 mm Hg ( P = 0.010; HR, 3.891), were independent predictors of graft loss within 6 mo after simultaneous Spx during LDLT.
CONCLUSIONS: Spx is a safe inflow modulation procedure with a positive impact on both postoperative complications and prognosis for most patients. However, patients with the 3 aforementioned independent factors could experience graft loss after LDLT.
摘要：
背景：门静脉压力调制的共识，包括脾切除术（Spx），建立活体肝移植(LDLT)后可预防门静脉高压相关并发症.然而,关于LDLT期间同时Spx后移植物丢失的危险因素的证据很少.这项研究旨在确定LDLT期间同时Spx后移植物丢失的独立预测因子。
方法：收集1997年至2021年接受LDLT的655名接受者的数据，并分为同时Spx组（n=461）和非Spx组（n=194）。
结果：同时Spx组血清总胆红素水平明显降低，排出的腹水体积，术后第14天凝血酶原时间-国际标准化比率高于无Spx组（各P<0.001）。小体积移植物综合征的发生率（P<0.001），急性细胞排斥反应（P=0.002），和脓毒症(P=0.007)在Spx组中显著降低。Spx组的移植物存活率明显优于非Spx组(P<0.001;风险比[HR],1.788；95%置信区间，1.214-2.431)。多变量分析显示，3个变量，血小板计数≤4.0×104/mm3(P=0.029；HR，2.873),供者年龄≥60岁(P=0.013；HR，6.693),闭合时的门静脉压≥20mmHg（P=0.010；HR，3.891),是LDLT期间同时进行Spx后6个月内移植物丢失的独立预测因子。
结论：Spx是一种安全的流入调节程序，对大多数患者的术后并发症和预后都有积极影响。然而,具有上述3个独立因素的患者在LDLT后可能出现移植物丢失.
方法：收集1997年至2021年接受LDLT的655名接受者的数据，并分为同时Spx组（n=461）和非Spx组（n=194）。
结果：同时Spx组血清总胆红素水平明显降低，排出的腹水体积，术后第14天凝血酶原时间-国际标准化比率高于无Spx组（各P<0.001）。小体积移植物综合征的发生率（P<0.001），急性细胞排斥反应（P=0.002），和脓毒症(P=0.007)在Spx组中显著降低。Spx组的移植物存活率明显优于非Spx组(P<0.001;风险比[HR],1.788；95%置信区间，1.214-2.431)。多变量分析显示，3个变量，血小板计数≤4.0×104/mm3(P=0.029；HR，2.873),供者年龄≥60岁(P=0.013；HR，6.693),闭合时的门静脉压≥20mmHg（P=0.010；HR，3.891),是LDLT期间同时进行Spx后6个月内移植物丢失的独立预测因子。
结论：Spx是一种安全的流入调节程序，对大多数患者的术后并发症和预后都有积极影响。然而,具有上述3个独立因素的患者在LDLT后可能出现移植物丢失.
