Partial splenectomy in children undergoing liver transplantation or venous shunt for severe hypersplenism: A case control comparative study - 06/07/22
, Sophie Chopinet c, Emilie Gregoire c, Laurent Milot d, Philippe Petit e, Barbara Rohmer f, Bertrand Roquelaure g, Anne Dariel h, Nicoleta Panait h, Jean Hardwigsen c, Jérôme Dumortier a, bHighlights |
• | Hypersplenism is potentially life-threatening in children with portal hypertension and can persist after liver transplantation or portosystemic shunt. |
• | Retrospective data from 16 children who underwent partial splenectomy and liver transplantation or portosystemic shunt were collected. |
• | Partial splenectomy can be added to liver transplantation or portosystemic shunt and is effective and safe to treat severe hypersplenism. |
Abstract |
Background and aim |
Hypersplenism is a consequence of portal hypertension and splenomegaly secondary to cirrhosis or portal cavernoma in children. In order to avoid persistent hypersplenism and splenomegaly after liver transplantation (LT) or venous shunt (VS), partial splenectomy (PS) may represent a relevant therapeutic option. The aim of this retrospective study was to evaluate the results of PS performed in children presenting hypersplenism.
Methods |
The following end-points were evaluated: (1) reversion of hypersplenism and its durability over time, (2) postoperative outcome, (3) courses of spleen size and volume and (4) comparison to a control group in which PS was not performed.
Results |
Between 1996 and 2020, 16 children underwent PS associated with LT (8 cases) for cirrhosis or VS (8 cases) for portal cavernoma. From Day 0 to 1 month, mean platelet and white blood cell counts (WBC) dramatically improved from 48 ± 19 at day 0 to 176 ± 70 × 109/L (P < 0.0001) and from 2469 ± 853 to 7198 ± 3982/L (P = 0.001) respectively. PS allowed significant reduction of splenic length and volume from 176 ± 33 to 112 ± 24 cm (P < 0.0001) and from 1228 ± 464 to 450 ± 297 cm3 (P = 0.0003) respectively. After a mean follow-up of 92.6 ± 84.7 months (range: 4.1–210.7), 14 patients are alive with normal platelet and WBC counts and persistent spleen size reduction. Compared to control group, PS was associated with a significant platelet count rise from baseline to one year.
Conclusions |
PS appears to be effective for treatment of hypersplenism and splenomegaly in combination with LT or VS without compromising outcome.
Le texte complet de cet article est disponible en PDF.Keywords : Hypersplenism, Splenomegaly, Partial splenectomy, Liver transplantation, Venous shunt, Outcome
Abbreviations : LT, VS, PS, WBC, SL, SV, CT, PHSLR, MRS, LLS, LD, LL, WL, SSSRS, GRWR, D, W, M, Y
Plan
| This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. |
Vol 46 - N° 6
Article 101929- juin 2022 Retour au numéro
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