Effect Of Preoperative Splenectomy Plus Esophagogastric Devascularization On Liver Transplantation In Patients With Portal Hypertension

Objective:To investigate the effect of preoperative splenectomy plus esophagogastric devascularization on liver transplantation(LT)in patients with portal hypertension(PHT).Methods:Retrospective analysis the clinical data of 364 patients undergone liver transplantation in Fuzhou General Hospital Hepatobiliary Surgery Department from January 2005 to February 2015.A total of 245 cases were excluded from liver cancer,liver failure,and finally there were 119 cases included in this study.The subjects were divided into two groups according to whether or not undergone the splenectomy plus esophagogastric devascularization: splenectomy plus esophagogastric devascularization group(n=32),control group(n=87).The postoperative liver function recovery condition,operation time,blood loss and blood transfusion volume during operation,postoperative pulmonary infection rate,incidence of biliary complications,complication rate(including pulmonary infection and biliary complications),survival rate,postoperative platelet recovery were compared between two groups.The time of hospitalization and the cost of hospitalization were also analyzed.Results:A total of 119 liver transplant patients were analyzed.The operation time was significant longer in splenectomy plus esophagogastric devascularization group(P<0.001).The cost of hospitalization,the blood loss and transfusion volume during operation as well as the incidence of postoperative complications were significantly higher in splenectomy plus esophagogastric devascularizaiton group(P < 0.05).There were no significant difference in the time of hospitalization and 3-year survival rate after operation between two groups(P>0.05).Compared with the control group,the liver function recovery condition of splenectomy plus esophagogastric devascularization group were as follows: The level of transaminase remained higher until 30 days after LT operation,reaching the normal level.The level of alanine transaminase(ALT)was significantly higher in 1,3,7 days after operation(P<0.05),while the level of aspartate aminotransferase(AST)was significantly higher in 1,3,5,7,30 days after operation(P<0.05),and the level of total bilirubin was higher in 30 days after operation(P<0.05).The number of platelets in plenectomy plus esophagogastric devascularization group were obviously increase after LT operation and remained in a high level;however that in control group were increase in a slow speed and remained in a lower level,which had a significant difference between two groups in 3,5,7,15,30 days after operation(P<0.05).Conclusions:The operation time,hospitalization cost,blood loss and transfusion volume during operation as well as the incidence of postoperative complications of PHT patients undergone liver transplantation were higher in plenectomy plus esophagogastric devascularization group.In addition,even the recovery of liver function had significant difference in early stage after operation,the levels of ALT and AST in two groups were tend to be normal on 1 month after operation and had little difference.Performance of devascularization before LT operation was effective in preventing thrombocytopenia after LT operation.