Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus

Heng-Cheng Chu, Chung-Bao Hsieh, Kuo-Feng Hsu, Hsiu-Lung Fan, Tsai-Yuan Hsieh, Teng-Wei Chen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated. Methods Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis. Results Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups. Conclusion Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT. © 2015 Elsevier Inc. All rights reserved.
Original languageEnglish
Pages (from-to)180-186
Number of pages7
JournalAmerican Journal of Surgery
Volume209
Issue number1
DOIs
Publication statusPublished - 2015
Externally publishedYes

Fingerprint

Splenectomy
Hepacivirus
Liver Transplantation
Hypersplenism
Splenic Vein
Transplants
Therapeutics
Blood Group Antigens
Portal Vein
Platelet Count
Leukocyte Count
Venous Thrombosis
Sepsis
Thrombosis
Fibrosis
Survival Rate
Transplantation
Liver

Keywords

  • Anti-viral therapy
  • Liver transplantation
  • Splenectomy
  • Splenectomy complication
  • Sustained viral response
  • interferon
  • ribavirin
  • alpha interferon
  • antivirus agent
  • macrogol derivative
  • peginterferon alpha2a
  • peginterferon alpha2b
  • recombinant protein
  • adult
  • antiviral therapy
  • Article
  • clinical feature
  • female
  • follow up
  • hepatitis C
  • Hepatitis C virus
  • human
  • leukocyte count
  • liver function
  • liver transplantation
  • major clinical study
  • male
  • overall survival
  • portal vein thrombosis
  • splenectomy
  • splenic vein
  • thrombocyte count
  • comparative study
  • complication
  • drug administration
  • drug combination
  • evaluation study
  • Hepatitis C, Chronic
  • hypersplenism
  • liver cirrhosis
  • middle aged
  • multimodality cancer therapy
  • retrospective study
  • treatment outcome
  • virology
  • Adult
  • Antiviral Agents
  • Combined Modality Therapy
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Hypersplenism
  • Interferon-alpha
  • Liver Cirrhosis
  • Liver Transplantation
  • Male
  • Middle Aged
  • Polyethylene Glycols
  • Recombinant Proteins
  • Retrospective Studies
  • Ribavirin
  • Treatment Outcome

Cite this

Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus. / Chu, Heng-Cheng; Hsieh, Chung-Bao; Hsu, Kuo-Feng; Fan, Hsiu-Lung; Hsieh, Tsai-Yuan; Chen, Teng-Wei.

In: American Journal of Surgery, Vol. 209, No. 1, 2015, p. 180-186.

Research output: Contribution to journalArticle

Chu, Heng-Cheng ; Hsieh, Chung-Bao ; Hsu, Kuo-Feng ; Fan, Hsiu-Lung ; Hsieh, Tsai-Yuan ; Chen, Teng-Wei. / Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus. In: American Journal of Surgery. 2015 ; Vol. 209, No. 1. pp. 180-186.
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abstract = "Background Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated. Methods Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis. Results Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups. Conclusion Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT. {\circledC} 2015 Elsevier Inc. All rights reserved.",
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author = "Heng-Cheng Chu and Chung-Bao Hsieh and Kuo-Feng Hsu and Hsiu-Lung Fan and Tsai-Yuan Hsieh and Teng-Wei Chen",
note = "Export Date: 22 March 2016 CODEN: AJSUA 通訊地址: Chen, T.-W.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Taiwan 化學物質/CAS: ribavirin, 36791-04-5; peginterferon alpha2a, 198153-51-4; peginterferon alpha2b, 215647-85-1; Antiviral Agents; Interferon-alpha; peginterferon alfa-2a; peginterferon alfa-2b; Polyethylene Glycols; Recombinant Proteins; Ribavirin 參考文獻: Starzl, T.E., Murase, N., Marcos, A., History of liver and multivisceral transplantation (2005) Transplantation of the Liver, pp. 3-22. , R.W. Busuttil, G.K. Klintmalm, 2nd ed. Elsevier Saunders Philadelphia; Sugawara, Y., Yamamoto, J., Shimada, K., Splenectomy in patients with hepatocellular carcinoma and hypersplenism (2000) J Am Coll Surg, 190, pp. 446-450; Morihara, D., Kobayashi, M., Ikeda, K., Effectiveness of combination therapy of splenectomy and long-term interferon in patients with hepatitis C virus-related cirrhosis and thrombocytopenia (2009) Hepatol Res, 39, pp. 439-447; Tashiro, H., Itamoto, T., Ohdan, H., Should splenectomy be performed for hepatitis C patients undergoing living-donor liver transplantation? (2007) J Gastroenterol Hepatol, 22, pp. 959-960; Ikegami, T., Shimada, M., Imura, S., Current concept of small-for-size grafts in living donor liver transplantation (2008) Surg Today, 38, pp. 971-982; Egawa, H., Teramukai, S., Haga, H., Present status of ABO-incompatible living donor liver transplantation in Japan (2008) Hepatology, 47, pp. 143-152; Alexandre, G.P., Squifflet, J.P., De Bruy{\`e}re, M., Present experiences in a series of 26 ABO-incompatible living donor renal allografts (1987) Transpl Proc, 19, pp. 4538-4542; Neumann, U.P., Langrehr, J.M., Kaisers, U., Simultaneous splenectomy increases risk for opportunistic pneumonia in patients after liver transplantation (2002) Transpl Int, 15, pp. 226-232; Kinjo, N., Kawanaka, H., Akahoshi, T., Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension (2010) Br J Surg, 97, pp. 910-916; Yoshizumi, T., Taketomi, A., Soejima, Y., The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft (2008) Transpl Int, 21, pp. 833-842; Chen, X.P., Wu, Z.D., Huang, Z.Y., Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism (2005) Br J Surg, 92, pp. 334-339; Ushitora, Y., Tashiro, H., Takahashi, S., Splenectomy in chronic hepatic disorders: Portal vein thrombosis and improvement of liver function (2011) Dig Surg, 28, pp. 9-14; Jiang, H., Meng, F., Li, W., Splenectomy ameliorates acute multiple organ damage induced by liver warm ischemia reperfusion in rats (2007) Surgery, 141, pp. 32-40; Ito, T., Kiuchi, T., Yamamoto, H., Changes in portal venous pressure in the early phase after living donor liver transplantation: Pathogenesis and clinical implications (2003) Transplantation, 75, pp. 1313-1317; Konishi, N., Ishizaki, Y., Sugo, H., Impact of a left-lobe graft without modulation of portal flow in adult-to-adult living donor liver transplantation (2008) Am J Transpl, 8, pp. 170-174; Takahashi, K., Effects and complications of splenectomy (2004) Accommodation in ABO-incompatible Kidney Transplantation, pp. 81-83. , K. Takahashi, Elsevier Amsterdam; Starzl, T.E., Marchioro, T.L., Talmage, D.W., Splenectomy and thymectomy in human renal homotransplantation (1963) Proc Soc Exp Biol Med, 113, pp. 929-932; Takahashi, K., Saito, K., Takahara, S., Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan (2004) Am J Transplant, 4, pp. 1089-1096; Egawa, H., Ohmori, K., Haga, H., B-cell surface marker analysis for improvement of rituximab prophylaxis in ABO-incompatible adult living donor liver transplantation (2007) Liver Transpl, 13, pp. 579-588; Ikegami, T., Taketomi, A., Soejima, Y., Rituximab, IVIG, and plasma exchange without graft local infusion treatment: A new protocol in ABO incompatible living donor liver transplantation (2009) Transplantation, 88, pp. 303-307; Forman, L.M., Lewis, J.D., Berlin, J.A., The association between hepatitis C infection and survival after orthotopic liver transplantation (2002) Gastroenterology, 122, pp. 889-896; Heydtmann, M., Freshwater, D., Dudley, T., Pegylated interferon alpha-2b for patients with HCV recurrence and graft fibrosis following liver transplantation (2006) Am J Transplant, 6, pp. 825-833; Ikezawa, K., Naito, M., Yumiba, T., Splenectomy and antiviral treatment for thrombocytopenic patients with chronic hepatitis C virus infection (2010) J Viral Hepat, 17, pp. 488-492; Sekiguchi, T., Nagamine, T., Takagi, H., Reduction of virus burden-induced splenectomy in patients with liver cirrhosis related to hepatitis C virus infection (2006) World J Gastroenterol, 12, pp. 2089-2094; Hashimoto, N., Shimoda, S., Kawanaka, H., Modulation of CD4+ T cell responses following splenectomy in hepatitis C virus-related liver cirrhosis (2011) Clin Exp Immunol, 165, pp. 243-250; Ge, D., Fellay, J., Thompson, A.J., Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance (2009) Nature, 461, pp. 399-401; Thompson, A.J., Muir, A.J., Sulkowski, M.S., Interleukin-28B polymorphism improves viral kinetics and is the strongest pretreatment predictor of sustained virologic response in genotype hepatitis C virus (2010) Gastroenterology, 139, pp. 120-129e18; Thomas, D.L., Thio, C.L., Martin, M.P., Genetic variation in IL28B and spontaneous clearance of hepatitis C virus (2009) Nature, 461, pp. 798-801; Samimi, F., Irish, W.D., Eghtesad, B., Role of splenectomy in human liver transplantation under modern-day immunosuppression (1998) Dig Dis Sci, 43, pp. 1931-1937; Krauth, M.T., Lechner, K., Neugebauer, E.A.M., The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - An unresolved issue (2008) Haematologica, 93, pp. 1227-1232; Ikeda, M., Sekimoto, M., Takiguchi, S., High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: A prospective study with contrast-enhanced CT scan (2005) Ann Surg, 241, pp. 208-216; Ikegami, T., Toshima, T., Takeishi, K., Bloodless splenectomy during liver transplantation for terminal liver diseases with portal hypertension (2009) J Am Coll Surg, 208, pp. 1-e4",
year = "2015",
doi = "10.1016/j.amjsurg.2014.03.004",
language = "English",
volume = "209",
pages = "180--186",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
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}

TY - JOUR

T1 - Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus

AU - Chu, Heng-Cheng

AU - Hsieh, Chung-Bao

AU - Hsu, Kuo-Feng

AU - Fan, Hsiu-Lung

AU - Hsieh, Tsai-Yuan

AU - Chen, Teng-Wei

N1 - Export Date: 22 March 2016 CODEN: AJSUA 通訊地址: Chen, T.-W.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Taiwan 化學物質/CAS: ribavirin, 36791-04-5; peginterferon alpha2a, 198153-51-4; peginterferon alpha2b, 215647-85-1; Antiviral Agents; Interferon-alpha; peginterferon alfa-2a; peginterferon alfa-2b; Polyethylene Glycols; Recombinant Proteins; Ribavirin 參考文獻: Starzl, T.E., Murase, N., Marcos, A., History of liver and multivisceral transplantation (2005) Transplantation of the Liver, pp. 3-22. , R.W. Busuttil, G.K. Klintmalm, 2nd ed. Elsevier Saunders Philadelphia; Sugawara, Y., Yamamoto, J., Shimada, K., Splenectomy in patients with hepatocellular carcinoma and hypersplenism (2000) J Am Coll Surg, 190, pp. 446-450; Morihara, D., Kobayashi, M., Ikeda, K., Effectiveness of combination therapy of splenectomy and long-term interferon in patients with hepatitis C virus-related cirrhosis and thrombocytopenia (2009) Hepatol Res, 39, pp. 439-447; Tashiro, H., Itamoto, T., Ohdan, H., Should splenectomy be performed for hepatitis C patients undergoing living-donor liver transplantation? (2007) J Gastroenterol Hepatol, 22, pp. 959-960; Ikegami, T., Shimada, M., Imura, S., Current concept of small-for-size grafts in living donor liver transplantation (2008) Surg Today, 38, pp. 971-982; Egawa, H., Teramukai, S., Haga, H., Present status of ABO-incompatible living donor liver transplantation in Japan (2008) Hepatology, 47, pp. 143-152; Alexandre, G.P., Squifflet, J.P., De Bruyère, M., Present experiences in a series of 26 ABO-incompatible living donor renal allografts (1987) Transpl Proc, 19, pp. 4538-4542; Neumann, U.P., Langrehr, J.M., Kaisers, U., Simultaneous splenectomy increases risk for opportunistic pneumonia in patients after liver transplantation (2002) Transpl Int, 15, pp. 226-232; Kinjo, N., Kawanaka, H., Akahoshi, T., Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension (2010) Br J Surg, 97, pp. 910-916; Yoshizumi, T., Taketomi, A., Soejima, Y., The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft (2008) Transpl Int, 21, pp. 833-842; Chen, X.P., Wu, Z.D., Huang, Z.Y., Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism (2005) Br J Surg, 92, pp. 334-339; Ushitora, Y., Tashiro, H., Takahashi, S., Splenectomy in chronic hepatic disorders: Portal vein thrombosis and improvement of liver function (2011) Dig Surg, 28, pp. 9-14; Jiang, H., Meng, F., Li, W., Splenectomy ameliorates acute multiple organ damage induced by liver warm ischemia reperfusion in rats (2007) Surgery, 141, pp. 32-40; Ito, T., Kiuchi, T., Yamamoto, H., Changes in portal venous pressure in the early phase after living donor liver transplantation: Pathogenesis and clinical implications (2003) Transplantation, 75, pp. 1313-1317; Konishi, N., Ishizaki, Y., Sugo, H., Impact of a left-lobe graft without modulation of portal flow in adult-to-adult living donor liver transplantation (2008) Am J Transpl, 8, pp. 170-174; Takahashi, K., Effects and complications of splenectomy (2004) Accommodation in ABO-incompatible Kidney Transplantation, pp. 81-83. , K. Takahashi, Elsevier Amsterdam; Starzl, T.E., Marchioro, T.L., Talmage, D.W., Splenectomy and thymectomy in human renal homotransplantation (1963) Proc Soc Exp Biol Med, 113, pp. 929-932; Takahashi, K., Saito, K., Takahara, S., Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan (2004) Am J Transplant, 4, pp. 1089-1096; Egawa, H., Ohmori, K., Haga, H., B-cell surface marker analysis for improvement of rituximab prophylaxis in ABO-incompatible adult living donor liver transplantation (2007) Liver Transpl, 13, pp. 579-588; Ikegami, T., Taketomi, A., Soejima, Y., Rituximab, IVIG, and plasma exchange without graft local infusion treatment: A new protocol in ABO incompatible living donor liver transplantation (2009) Transplantation, 88, pp. 303-307; Forman, L.M., Lewis, J.D., Berlin, J.A., The association between hepatitis C infection and survival after orthotopic liver transplantation (2002) Gastroenterology, 122, pp. 889-896; Heydtmann, M., Freshwater, D., Dudley, T., Pegylated interferon alpha-2b for patients with HCV recurrence and graft fibrosis following liver transplantation (2006) Am J Transplant, 6, pp. 825-833; Ikezawa, K., Naito, M., Yumiba, T., Splenectomy and antiviral treatment for thrombocytopenic patients with chronic hepatitis C virus infection (2010) J Viral Hepat, 17, pp. 488-492; Sekiguchi, T., Nagamine, T., Takagi, H., Reduction of virus burden-induced splenectomy in patients with liver cirrhosis related to hepatitis C virus infection (2006) World J Gastroenterol, 12, pp. 2089-2094; Hashimoto, N., Shimoda, S., Kawanaka, H., Modulation of CD4+ T cell responses following splenectomy in hepatitis C virus-related liver cirrhosis (2011) Clin Exp Immunol, 165, pp. 243-250; Ge, D., Fellay, J., Thompson, A.J., Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance (2009) Nature, 461, pp. 399-401; Thompson, A.J., Muir, A.J., Sulkowski, M.S., Interleukin-28B polymorphism improves viral kinetics and is the strongest pretreatment predictor of sustained virologic response in genotype hepatitis C virus (2010) Gastroenterology, 139, pp. 120-129e18; Thomas, D.L., Thio, C.L., Martin, M.P., Genetic variation in IL28B and spontaneous clearance of hepatitis C virus (2009) Nature, 461, pp. 798-801; Samimi, F., Irish, W.D., Eghtesad, B., Role of splenectomy in human liver transplantation under modern-day immunosuppression (1998) Dig Dis Sci, 43, pp. 1931-1937; Krauth, M.T., Lechner, K., Neugebauer, E.A.M., The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - An unresolved issue (2008) Haematologica, 93, pp. 1227-1232; Ikeda, M., Sekimoto, M., Takiguchi, S., High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: A prospective study with contrast-enhanced CT scan (2005) Ann Surg, 241, pp. 208-216; Ikegami, T., Toshima, T., Takeishi, K., Bloodless splenectomy during liver transplantation for terminal liver diseases with portal hypertension (2009) J Am Coll Surg, 208, pp. 1-e4

PY - 2015

Y1 - 2015

N2 - Background Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated. Methods Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis. Results Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups. Conclusion Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT. © 2015 Elsevier Inc. All rights reserved.

AB - Background Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated. Methods Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis. Results Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups. Conclusion Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT. © 2015 Elsevier Inc. All rights reserved.

KW - Anti-viral therapy

KW - Liver transplantation

KW - Splenectomy

KW - Splenectomy complication

KW - Sustained viral response

KW - interferon

KW - ribavirin

KW - alpha interferon

KW - antivirus agent

KW - macrogol derivative

KW - peginterferon alpha2a

KW - peginterferon alpha2b

KW - recombinant protein

KW - adult

KW - antiviral therapy

KW - Article

KW - clinical feature

KW - female

KW - follow up

KW - hepatitis C

KW - Hepatitis C virus

KW - human

KW - leukocyte count

KW - liver function

KW - liver transplantation

KW - major clinical study

KW - male

KW - overall survival

KW - portal vein thrombosis

KW - splenectomy

KW - splenic vein

KW - thrombocyte count

KW - comparative study

KW - complication

KW - drug administration

KW - drug combination

KW - evaluation study

KW - Hepatitis C, Chronic

KW - hypersplenism

KW - liver cirrhosis

KW - middle aged

KW - multimodality cancer therapy

KW - retrospective study

KW - treatment outcome

KW - virology

KW - Adult

KW - Antiviral Agents

KW - Combined Modality Therapy

KW - Drug Administration Schedule

KW - Drug Therapy, Combination

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hypersplenism

KW - Interferon-alpha

KW - Liver Cirrhosis

KW - Liver Transplantation

KW - Male

KW - Middle Aged

KW - Polyethylene Glycols

KW - Recombinant Proteins

KW - Retrospective Studies

KW - Ribavirin

KW - Treatment Outcome

U2 - 10.1016/j.amjsurg.2014.03.004

DO - 10.1016/j.amjsurg.2014.03.004

M3 - Article

VL - 209

SP - 180

EP - 186

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 1

ER -