Splenomegalia e ipersplenismo nei pazienti cirrotici prima e dopo trapianto ortotopico del fegato

Purpose. To measure the spleen length in patients with cirrhosis and portal hypertension with US and compare the measurements before and after orthotopic liver transplantation. To correlate splenic measures with laboratory data and Doppler flowmetry (mean portal vein flow velocity). Materials and methods. May, 1993, to January, 1997, fifteen patients with cirrhosis, portal hypertension and splenomegaly were examined and underwent orthotopic liver transplantation. The spleen length was measured before and after transplantation in 15/15 patients and it was also measured twice after transplantation in 10/15 patients. The mean portal venous flow velocity was measured before and after transplantation in 10/15 patients. The results were analyzed using the Student's t-test for paired and unpaired data; the association between the variables was evaluated by linear regression analysis; two-tailed p values were used. Results. At the first control after orthotopic liver transplantation (mean time from transplantation 5.5±2.6 months; range 2.5-12.5 months) a significant decrease was found in spleen length (179±32 to 149±30 mm, p=.0001; mean percent decrease=16.7±9.9%), hypersplenism disappeared in 9/13 cases, mean portal venous flow velocity, measured in 10/15 patients, showed an increasing trend (16.0±9.0 to 22.3±9.0 cm/s). At the first control the correlation between the values of mean portal flow velocity measured before and after transplantation was not significant (r=.558, p=.0939); the same was true for the correlation between mean portal flow velocity and spleen length. The second measurement of the spleen length after transplantation (mean time from the first follow-up 18.1±7.8 months; range 6.4-32.8 months) in 10/15 subjects demonstrated no significant changes in the spleen dimensions relative to the first examination (139±24 mm to 138±26 mm), and in 1/10 case hypersplenism disappeared. Conclusions. The measurement of the spleen length is proposed for the follow-up of the patients with cirrhosis and hypersplenism before and after orthotopic liver transplantation. In our study, the mean decrease in spleen length was 17% in the period from transplantation to the first US examination. In the patients who underwent a second measurement after transplantation no significant change in spleen length was observed.