Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Splenic artery steal syndrome after liver transplantation - prophylaxis or treatment?: A case report and literature review

  • Sofia Usai (Department of Surgical Sciences, Umberto I Hospital, Sapienza University of Rome) ;
  • Marco Colasanti (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital) ;
  • Roberto Luca Meniconi (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital) ;
  • Stefano Ferretti (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital) ;
  • Nicola Guglielmo (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital) ;
  • Germano Mariano (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital) ;
  • Giammauro Berardi (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital) ;
  • Matteo Cinquepalmi (Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome) ;
  • Marco Angrisani (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital) ;
  • Giuseppe Maria Ettorre (General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital)
  • Received : 2022.01.18
  • Accepted : 2022.03.10
  • Published : 2022.11.30
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Abstract

Splenic artery steal syndrome (SASS) is a cause of graft hypoperfusion leading to the development of biliary tract complications, graft failure, and in some cases to retransplantation. Its management is still controversial since there is no universal consensus about its prophylaxis and consequently treatment. We present a case of SASS that occurred 48 hours after orthotopic liver transplantation (OLTx) in a 56-year-old male patient with alcoholic cirrhosis and severe portal hypertension, and who was successfully treated by splenic artery embolization. A literature search was performed using the PubMed database, and a total of 22 studies including 4,789 patients who underwent OLTx were relevant to this review. A prophylactic treatment was performed in 260 cases (6.2%) through splenic artery ligation in 98 patients (37.7%) and splenic artery banding in 102 (39.2%). In the patients who did not receive prophylaxis, SASS occurred after OLTx in 266 (5.5%) and was mainly treated by splenic artery embolization (78.9%). Splenic artery ligation and splenectomies were performed, respectively, in 6 and 20 patients (2.3% and 7.5%). The higher rate of complications registered was represented by biliary tract complications (9.7% in patients who received prophylaxis and 11.6% in patients who developed SASS), portal vein thrombosis (respectively, 7.3% and 6.9%), splenectomy (4.8% and 20.9%), and death from sepsis (4.8% and 30.2%). Whenever possible, prevention is the best way to approach SASS, considering all the potential damage arising from an arterial graft hypoperfusion. Where clinical conditions do not permit prophylaxis, an accurate risk assessment and postoperative monitoring are mandatory.

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References

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