Splenic Artery Embolization for Post-Liver Transplant Ascites

Abstract

Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. However, OLT may be associated with certain postoperative management challenges. Though refractory ascites (RA) is not a common complication post-OLT, it can have a significant impact on patient outcomes and quality of life. RA post-OLT can be caused by portal hyperperfusion. In this article, a systematic review of the literature was pursued to analyze the effectiveness of splenic artery embolization (SAE) with RA after OLT. Data sources included MEDLINE, EMBASE, and CENTRAL from inception to March 2024. Studies reporting on patients treated with SAE for the management of RA following OLT, from inception to March 2024, were included. Morbidity, mortality, and clinical resolution were synthesized through a narrative review. A total of eight articles were identified, including 80 patients. In the majority of the patients, the SAE was performed using a vascular plug. After SAE, no cases associated with mortality were reported. Severe complications (Clavien III) occurred in 2.5% (n = 2) of patients. The success rate, with clinical resolution of symptomatology (ascites), ranged in these articles between 97 and 100%. The approach to the management of RA post-OLT should focus on identifying the underlying cause. If the RA is associated with portal hyperperfusion, it can be managed with SAE. Particularly proximal SAE seems to be highly effective for the resolution of ascites and the procedure is associated with a low complication rate.

Keywords

liver transplant - splenic artery embolization - portal hyper flow - refractory ascites

Publikationsverlauf

Eingereicht: 26. Juni 2024

Angenommen: 16. September 2024

Artikel online veröffentlicht:
25. November 2024

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