Byron DuBois1, David Mobley2, Jeffrey F B Chick3, Ravi N Srinivasa4, Chad Wilcox4, Joshua Weintraub2. 1. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America; Department of Radiology, Division of Vascular and Interventional Radiology, Columbia University Medical Center, 177 Fort Washington Ave, Milstein Hospital - 4 Hudson North, New York, NY 10032, United States of America. Electronic address: byrond@med.umich.edu. 2. Department of Radiology, Division of Vascular and Interventional Radiology, Columbia University Medical Center, 177 Fort Washington Ave, Milstein Hospital - 4 Hudson North, New York, NY 10032, United States of America. 3. Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304, United States of America. 4. Department of Radiology, Division of Interventional Radiology, University of California Los Angeles, 757 Western Plaza, Los Angeles, CA 90095, United States of America.
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 count out to 2 years and platelet count 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.
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 count out to 2 years and platelet count 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.
Authors: Ryan L Brunsing; Dustin Brown; Hashem Almahoud; Yuko Kono; Rohit Loomba; Irene Vodkin; Claude B Sirlin; Marcus T Alley; Shreyas S Vasanawala; Albert Hsiao Journal: J Magn Reson Imaging Date: 2021-02-16 Impact factor: 5.119