The Application Value Of Splenectomy Before Or Simultaneously In The Orthotopic Liver Transplantation

OBJECTIVE: To explore the clinical application value of splenectomy before or simultaneously in the orthotopic liver transplantation.METHODS: Between February 1999 and May 2005, 403 patients underwent consecutive Orthotopic Liver Transplantation (OLTx) at the First Affiliated Hospital of Zhejiang University School of Medicine. Twenty-nine of these patients had splenectomy (23 patients splenectomy before and 6 patients simultaneously in OLTx). These patients were compared with 58 randomly selected OLTx patients without splenectomy within the same time period. The operation time, bleeding, transfusion, infection, rejection, survival rate and the variety of the platelet post-operation were considered. RESULTS: The operation time was longer in splenectomized patients(splenectomy before and simultaneously in OLTx)compared with non-splenectomized patients (448.70±100.51, 526.67±99.93 vs 362.80±71.65, P<0.001, P<0.001), so were the transfusion quantity and the bacterial infection ratio after the operation(P<0.05). But therejection between the groups showed no statistical significance. The survival rate of thesplenectomized patients in transplantation was lower than the non-splenectomizedpatients(P=0.0001). The mean platelet quantity recovered to normal in the three groupsall 14 days post-transplantation, and was higher than normal in the two with splenectomy30 days post-transplantation.CONCLUSION: Both no benefits were found for either splenectomy before orsimultaneously in OLTx. Indication of splenectomy should be considered in particularlyselected patients.