| Objective:1.To evaluate the relief effect of orthotopic liver transplantation on hypersplenism after cirrhotic portal hypertension;2.To analyze the predictive factors of refractory hypersplenism after liver transplantation and evaluate its predictive efficacy,helps identify high-risk patients and guide treatment plan to reduce the incidence of refractory hypersplenism.Methods:Clinical data of 55 patients with end-stage liver disease and hypersplenism who underwent orthotopic liver transplantation were retrospectively analyzed.The relief effect of orthotopic liver transplantation on hypersplenism were evaluated by observing the changes of spleen volume,spleen thickness,portal vein velocity,platelet and white blood cell counts within 1 year of perioperative period.According to the inspection results of the observation end point,the patients were divided into hypersplenism recovery group and refractory hypersplenism group,and analyze the predictive factors of refractory hypersplenism after liver transplantation.The value of the prediction of refractory hypersplenism was evaluated by calculating its sensitivity,specificity,Yoden index,optimal threshold,area under the curve,positive likelihood ratio,and negative likelihood ratio.Results:(1)Postoperative spleen volume(562.90±49.16cm~3)was significantly decreased than preoperative(850.50±77.99cm~3)(P<0.05),and the reduction ratio was(31.70±2.76)%;(2)The spleen thickness at different time points after surgery was significantly lower than that before surgery(P<0.05),and stabilized 1 month after transplantation;(3)Portal flow velocity at different time points after surgery increased significantly compared with preoperative(P<0.05),and reached peak(380.70±21.80mm/s)1 month after transplantation,then began to decline,and stabilized 3 months after transplantation;(4)Platelet counts at different time points after surgery were significantly higher than that before surgery(P<0.05),and reached peak(193.40±10.36*10~9/L)2 weeks after transplantation and then began to fall back and keep steady 2 months after transplantation;(5)White blood cell counts at different time points after surgery were significantly higher than that before surgery(P<0.05),and reached peak(5.92±0.21*10~9/L)1 month after transplantation and then began to fall back and keep steady 3 months after transplantation;(6)The overall recovery rate of hypersplenism was(79.40±2.03)%within 1 year after operation;(7)Spleen thickness(R~2=0.59,P<0.05)and portal vein width(R~2=0.40,P<0.05)were positively correlated with spleen volume,platelet count(R~2=0.37,P<0.05)and white blood cell count(R~2=0.35,P<0.05)were negatively correlated with spleen volume;(8)T-test and two-class logistic regression analysis showed spleen volume(t=5.45,P<0.05),spleen thickness(t=3.57,P<0.05),platelet count(t=2.88,P<0.05)are predictors for refractory hypersplenism;(9)The predictive sensitivities(%)of spleen volume,spleen thickness and platelet count to refractory hypersplenism are 85.71,64.29,71.43,specificities(%)are 80.49,85.37,85.37,the Yoden indices are 0.66,0.50,0.57,the optimal thresholds are 885.06 cm~3,58 mm,and 46*10~9/L,the area under the curve are 0.86,0.75,0.77,the positive likelihood ratios are 4.39,4.39,4.88,and the negative likelihood ratios are 0.18,0.42,0.33,respectively.Conclusion:(1)Orthotopic liver transplantation can effectively alleviate most hypersplenism secondary to cirrhotic portal hypertension;using image post-processing technique to calculate spleen volume and combining clinical indicators such as blood routine and liver ultrasound can effectively evaluate the relief effect of liver transplantation for hypersplenism;(2)Spleen volume,spleen thickness,and platelet count are predictive factors for refractory hypersplenism after liver transplantation,which can help doctors identify high-risk patients who may complicate with refractory hypersplenism after surgery before liver transplantation. |
PDF Full Text Request