Simultaneous Splenic Artery Ligation During Adult Orthotopic Liver Transplantation Improves Surgical Outcomes

BACKGROUND: Portal hypertension and hyperactivity of the spleen are common in patients with end-stage liver disease (ESLD), significantly impacting the prognosis of liver transplantation. Splenic artery ligation (SAL) is a method to improve splenic hyperactivity and regulate blood flow to the liver, though its efficacy remains controversial. This study aims to elucidate the impact of simultaneous SAL during orthotopic liver transplantation (OLT), with a focus on postoperative liver function recovery, splenic hyperactivity, postoperative complications, and further assessment of the effectiveness of SAL in improving outcomes for adult OLT. METHODS: From July 2021 to August 2023, 332 OLTs were performed for patients with ESLD at the First Affiliated Hospital of Xi'an Jiaotong University. Among the cohort, intraoperative SAL was performed in 123 cases, whereas the remaining 209 patients did not receive this intervention. We performed propensity score matching (PSM) to compare postoperative recovery, complications, and survival rates between the two groups. RESULTS: After PSM, recipients undergoing SAL demonstrated enhanced early postoperative liver function recovery, improved postoperative splenic function, reduced postoperative hepatic artery resistance index, and decreased occurrences of postoperative intra-abdominal hemorrhage, acute kidney injury, hepatic artery thrombosis, and infection compared to those not undergoing SAL. Univariate and multivariate analysis indicated that undergoing SAL during OLT was a protective factor against postoperative intra-abdominal hemorrhage (HR 0.148; 95% CI 0.032-0.696, p = 0.015) and hepatic artery thrombosis (HR 0.172; 95% CI 0.036-0.815, p = 0.027). CONCLUSIONS: In recipients with severe splenomegaly and splenic hyperactivity identified during preoperative assessments, simultaneous SAL during OLT is deemed safe and effective, warranting consideration during the surgical procedure.