Treatment algorithm for the management of concomitant splenic artery aneurysms in adult Liver Transplant recipients.

Abstract

Background: The rupture of splenic artery aneurysms (SAAs) is a life-threatening complication with a high mortality rate, occurring mainly in patients with cirrhosis and portal hypertension. This study aimed to describe the clinical characteristics of concomitant SAAs in adult liver transplantation (LT) recipients and to report long-term outcomes of SAAs managed by our treatment algorithm.

Methods: Between January 2016 and December 2020, this single-center, retrospective, observational study included 2316 adult LT recipients. A total of 88 LT recipients (3.8%) with concomitant 130 SAAs were managed based on our treatment algorithm, which applied a more aggressive therapeutic option-surgical or endovascular treatment-mainly based on the location, number, and accessibility of SAAs. Clinical characteristics of SAAs and their long-term outcomes were analyzed.

Results: The most common SAA location was the splenic hilum (59.2%), and 65.9% of patients had single SAAs. Surgical ligation of the splenic artery and endovascular embolization of SAAs were performed in 51 (58.0%) and 37 (42.0%) patients, respectively. A high incidence of splenic infarction after SAA treatment (75.0%) was observed, which did not require additional invasive treatment. The incidence of splenic infarctions was significantly lower in patients receiving surgical ligation than in those receiving endovascular embolization (p<0.01). During the mean follow-up of 53 months, no case of SAA sac expansion and SAA-related or treatment-related mortality was observed.

Conclusion: Despite a high incidence of post-treatment splenic infarction, our treatment algorithm was safe and effective as an adjunctive treatment to prevent SAA-related mortality in adult LT recipients.