Predictive Factors For Improving Hypersplenism And Risk Factors For Complications After Partial Splenic Embolization

BackgroundAlthough partial splenic embolization (PSE) has been widely used for treatment ofleucocytoprenia and thrombocytopaenia in cirrhosis patients, the predictive factors forimproving hypersplenism and risk factors for complications after PSE are stillunclear.ObjectiveThe purpose of this study was1. To assess the efficacy and safety of PSE for leucocytoprenia andthrombocytopaenia in liver cirrhosis patients. 2. To investigate the predictive factors for platelet increase and the potential riskfactors for complications after PSE.3. To determine the suitable cut-off value of the splenic infracted degree.Materials and MethodsBetween January2008and December2011,70patients with hypersplenism causedby cirrhotic portal hypertension were treated with PSE in the third affiliated hospitalof Sun Yat-sen University. Of these patients,53with a follow-up more than onemonth who had complete clinical and imaging data were included in this study. Thechanges in peripheral blood cell parameters, including white blood cell (WBC) andplatelet (PLT) counts, at different follow-up point were evaluated. And the potentialpredictive factors for platelet increase and risk factors for complications after PSEwere examined retrospectively.ResultsThe53patients were at73occasions the objects for PSE with the aim to eliminatehypersplenism. Seven of them received two treatments, three patients received fourtreatments, one patients received five treatments, and the other42patients underwenttreatment on one occasion. The pretreatment splenic volume, non-infarcted splenicvolume, infarcted splenic volume and splenic infarction ratio were687.3(355.6) mL,259.0(141.0) mL,434.3(322.7) mL and (62.9±10.2) per cent. These53patients werefollowed up for a median of10.0(14.0) months after PSE (range,1-42months). And42of the patients had a follow-up more than6months,24had a follow-up more than1year,12had a follow-up more than2years. Compared with the pretreatment level, The PLT and WBC counts increasedsignificantly at1month,6months,1year and2years after PSE. In Pearson’s orSpearman’s correlation analysis, the cholinesterase (CHE) level, pretreatment splenicvolume, infarcted splenic volume and splenic infarction ratio showed a positivecorrelation with increase in PLT count at1month after PSE, whereas age showed anegative correlation; the CHE level, prothrombin activity (PTA) and splenic infarctionratio showed a positive correlation with increase in PLT count at6months after PSE,whereas non-infarcted splenic volume showed a negative correlation; in addition, thesplenic infarction ratio showed a positive correlation with increase in PLT count at1year after PSE, whereas non-infarcted splenic volume showed a negative correlation.After PSE, all patients experienced postembolization syndrom with a medianduration of6(3) days (range,3-16days). Of these patients,11(20.8%) hadcomplications following PSE, and PSE was not the cause of mortality in any of thecases. Complications after PSE were significantly associated with a large infarctedsplenic volume, a high splenic infarction ratio and a high Child-Pugh score.Conclution1. PSE is an safe and effective therapeutic modality for the treatment ofthrombocytopaenia and leucocytopaenia caused by hypersplenism secondary to livercirrhosis.2. The splenic infarction ratio and non-infarcted splenic volume, as the controllablefactors associated with the procedure of PSE, significantly affects the prolongedincrease in PLT counts after PSE.3. A large infarcted splenic volume, a high splenic infarction ratio and Child-Pughclass C are the risk factors for complications following PSE. 4. In patients with a large pretreatment splenic volume or Child-Pugh class Cdisease, a partitioned and repeated PSE might be a safer option to gain a sufficientimprovement of hypersplenism.