Splenic Artery Ligation Versus Splenectomy for Portal Inflow Modulation in Adult Living Donor Liver Transplant: Effects on Early Graft Function, A Prospective Study.

Objectives: Portal inflow modulation is currently an essential step in living donor liver transplantation, particularly among patients with portal hypertension who receive small grafts. This study compared splenic artery ligation with splenectomy as a method for portal inflow modulation.

Materials And Methods: We compared 31 consecutive prospective adult patients who had splenic artery ligation during living donorlivertransplant with either right or left lobe donation performed from July 2021 to March 2024 with 22 consecutive retrospective patients who had splenectomy performed immediately before July 2021.

Results: No differences were shown between splenic artery ligation and splenectomy groups in demographic data, indication, and Model for End-Stage Liver Disease score. Patients in the splenic artery ligation group had significantly smaller grafts than patients in the splenectomy group (graft-to-recipient weight ratio of 0.89 ± 0.23 vs 1.19 ± 0.24; P<.001) and less right lobes (41.9% [n=13] vs 90.9% [n=20]; P<.001).No significant differences between groups were shown for cold and warm ischemic times and estimated blood loss. Operative time was significantly shorter for patients in the splenic artery ligation versus splenectomy group (8.85 ± 1.33 vs 10.49 ± 0.75 h; P < .001). In the splenic artery ligation group, median portal vein pressure decreased from 19 (range, 16-23) to 14 (range, 11-20) mm Hg. In the splenectomy group, portal vein pressure decreased from 20.5 (range, 17-24) to 14.5 (range, 12-17) mm Hg. Both techniques showed no differences regarding effect on portal inflow modulation (P = .21). Incidence of small-for-size syndrome was not significantly different between groups.

Conclusion: Splenic artery ligation was not inferior to splenectomy as a method to perform portal inflow modulation to alleviate graft dysfunction in living donor liver transplant with portal hypertension.