Open Access
Digestive Disease Interventions 2017; 01(S 01): S111-S142
DOI: 10.1055/s-0037-1603724
Oral Presentations
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Current Understanding and Management of Splenic Steal Syndrome after Liver Transplant: A Systematic Review

Authors

  • Brian Tsui

    1   Case Western Reserve University School of Medicine, Cleveland, Ohio

  • Chaolun Li

    2   Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China

  • Baljendra Kapoor

    3   Imaging Institute, Cleveland Clinic, Section of Interventional Radiology, Cleveland, Ohio

  • Eunice Moon

    3   Imaging Institute, Cleveland Clinic, Section of Interventional Radiology, Cleveland, Ohio

  • Cristiano Quintini

    4   Department of General Surgery, Liver Transplant Center, Cleveland Clinic, Cleveland, Ohio

  • Weiping Wang

    5   Department of Radiology, Mayo Clinic, Jacksonville, Florida
Further Information

Publication History

Publication Date:
24 May 2017 (online)

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Background: Splenic steal syndrome (SSS) is a condition that can occur after orthotopic liver transplant (OLT). However, limited information is available about this condition.

Materials and Methods: An extensive literature search of studies performed through May 2016 was conducted to identify reports of angiographically confirmed SSS and its variants. All of the factors relevant to this disorder were collected and analyzed.

Results: A total of 219 cases of SSS and its variants were identified. The condition occurred in 4.7% of patients, and 93.7% of cases were diagnosed within the first 2 months after OLT. Conventional arteriography demonstrated nonocclusive hepatic artery hypoperfusion in all affected patients. Abnormal liver function was the most common clinical presentation, reported in 71.9% of cases. Less common presentations included thrombocytopenia, acute graft failure, and persistent ascites. On Doppler ultrasound, a high resistance index of the hepatic artery was present in 84.1% of patients. Increased spleen volume (≥829 mL) before OLT was suggestive of a potential risk for SSS. Splenic artery embolization (SAE) was performed in 94.7% of cases; this procedure immediately revised flow abnormalities on Doppler ultrasound and improved liver function tests in 96.3% of cases.

Conclusion: The risk factors and potential etiologies of SSS remain largely unknown. Future studies should investigate the significance of persistently increased resistance index and decreased perfusion in the hepatic artery after OLT. Collecting intraoperative hemodynamic data and performing Doppler ultrasound screening after OLT could potentially help clinicians to identify patients at high risk of arterial hypoperfusion and prevent arterial complications.


No conflict of interest has been declared by the author(s).