Publication date: Available online 27 November 2018
Source: Clinical Imaging
Author(s): Byron DuBois, David Mobley, Jeffrey Chick, Ravi Srinivasa, Chad Wilcox, Joshua Weintraub
Abstract
Purpose
To report the effect of partial splenic embolization (PSE) on hematological indices and the procedure's safety in pre- and post-liver transplant (LT) patients.
Materials and methods
A single-center retrospective study evaluating all patients who underwent PSE over a 16-year period was performed. Inclusion criteria were splenomegaly confirmed by imaging and at least one of the following cytopenias: hemoglobin ≤10 g/dL, WBC count ≤1500 μL−1, or platelet count ≤100,000 μL−1. 38 of 102 patients (37%) met criteria (24 pre- and 14 post-LT) for a total of 40 PSEs.
Results
No effect was seen on median hemoglobin beyond 2 weeks post-PSE. There was a significant and sustained increase in median WBC counts (from 3400 μL−1 to 5400 μL−1 at 2 years) and platelet count (from 65,000 μL−1 to 117,000 μL−1 at 3.5 years). In 6 out of 40 PSEs (15%) a major complication occurred which included pleural effusion, ascites, spontaneous bacterial peritonitis, pneumonia, and inferior vena cava thrombus. Similar efficacy was observed in pre- and post-LT cohorts, with a trend toward higher complication rate in pre-LT patients.
Conclusions
PSE is efficacious in increasing WBC out to 2 years and platelet counts out to 3.5 years in patients with hypersplenism. Efficacy and safety appeared independent of pre- or post-LT status. The intervention is associated with major complications and special care should be taken when selecting patients for PSE.
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