Transition of Spleen Volume Long After Pediatric Living Donor Liver Transplantation for Biliary Atresia.

Abstract Purpose After undergoing the Kasai procedure for biliary atresia (BA), most patients develop severe splenomegaly that tends to be improved by liver transplantation. However, fluctuations in splenic volume long after transplantation remain to be elucidated. Patients and Methods Seventy-one consecutive patients who had undergone pediatric living donor liver transplantation (LDLT) for BA were followed up in our outpatient clinic for 5 years. They were classified into 3 groups according to their clinical outcomes: a good course group (GC, n = 41) who were maintained on only 1 or without an immunosuppressant, a liver dysfunction group (LD, n = 18) who were maintained on 2 or 3 types of immunosuppressants, and a vascular complication group (VC, n = 11). Splenic and hepatic volumes were calculated by computed tomography in 464 examinations and the values compared before and after the treatment, especially in the VC group. Results Splenic volume decreased exponentially in the GC group, with splenic volume to standard spleen volume ratio (SD) being 1.59 (0.33) 5 years after liver transplantation. Splenic volume to standard spleen volume ratios were greater in the VC and LD groups than in the GC group. Patients in the VC group with portal vein stenosis developed liver atrophy and splenomegaly, whereas those with hepatic vein stenosis developed hepatomegaly and splenomegaly. Interventional radiation therapy tended to improve the associated symptoms. Conclusions Fluctuations in splenic volume long after pediatric LDLT for BA may reflect various clinical conditions. Evaluation of both splenic and hepatic volumes can facilitate understanding clinical conditions following pediatric LDLT. Highlights • There is still minimal information available regarding the fluctuation of the spleen volume long after pediatric living donor liver transplantation (LDLT) for biliary atresia (BA). Data on the relationships among spleen volume, liver volume, and post liver transplantation (LTx) complications long after LTx are also scarce. In this study we measured the sequential changes in the spleen and liver volumes after pediatric LDLT for BA in patients followed up for more than 5 years in our outpatient clinic. • This article is the first report shedding light on the relationship between spleen and liver volume related to complications such as vascular or biliary complication after pediatric LDLT for BA in patients followed up for more than 5 years. • This information could be helpful for post-LDLT follow-up, especially in recipients after pediatric living donor liver transplantation for BA. [ABSTRACT FROM AUTHOR]