Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients

doi:10.4240/wjgs.v14.i9.930

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Sep 27, 2022; 14(9): 930-939
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.930

Table 1 Patients’ characteristics

	Nonsplenectomy (n = 85)	Splenectomy (n = 35)	P value
Age (yr), median (range)	57 (37-69)	57 (37-69)	0.667
Gender, n (%)			0.107
Male	67 (78.8)	22 (62.9)
Female	18 (21.2)	13 (37.1)
BMI, median (range)	24.2 (17.4-43.8)	24.6 (18.4-43.3)	0.707
Underlying liver disease, n (%)
HBV	66 (77.6)	14 (40.0)	< 0.001^a
HCV	22 (25.9)	23 (65.7)	< 0.001^a
Alcoholism	13 (15.3)	4 (11.4)	0.775
Signs of portal hypertension, n (%)
Ascites	43 (50.6)	19 (54.3)	0.841
Hepatic encephalopathy	35 (41.2)	13 (37.1)	0.838
Varices bleeding	19 (22.4)	12 (34.3)	0.251
Comorbidity, n (%)
Hypertension	20 (23.5)	9 (25.7)	0.817
Diabetes mellitus	40 (47.1)	11 (31.4)	0.155
Preoperative serum tests, median (range)
White blood count (/uL)	4600 (1480-11200)	3500 (1350-12200)	0.120
Platelet count (/uL)	80000 (26000-279000)	64000 (27000-155000)	0.003^a
Neutrophil–lymphocyte ratio	2.44 (0.51-24.18)	3.2 (0.91-21.33)	0.273
Platelet–lymphocyte ratio	78.49 (36.80-284.01)	71.19 (28.53-188.08)	0.386
Total bilirubin (mg/dL)	1.4 (0-38.9)	1.6 (0.4-57.1)	0.984
Creatinine (mg/dL)	0.9 (0.4-10.1)	0.8 (0.5-1.3)	0.578
Ammonia (ug/dL)	99 (0-337)	99 (30-560)	0.737
Albumin (g/dL)	3.2 (1.2-5.3)	3.3 (2.2-5.1)	0.922
Glucose (mg/dL)	115 (0-457)	118 (82-312)	0.956
INR	1.1 (0.9-2.7)	1.2 (0.9-2.1)	0.819
MELD scores	11 (6-32)	11 (6-30)	0.494
AFP (ng/mL)	7.0 (0.5-1190.0)	14.0 (2.0-2170.0)	0.012^a
Surgical factors
Surgical type, n (%)			0.276
DDLT	26 (30.6)	6 (17.1)
LDLT	56 (65.9)	28 (80)
SLT	3 (3.5)	1 (2.9)
Graft type, n (%)			0.120
Whole graft	27 (31.8)	6 (17.1)
Partial graft	58 (68.2)	29 (82.9)
GRWR < 0.8	12 (14.1)	6 (17.1)	0.673
Blood loss (mL), median (range)	1600 (200-14400)	1350 (260-11000)	0.519
Operative time (minutes), median (range)	552 (360-1035)	630 (420-870)	0.001^a
Pathology
Tumor size (cm)	2.2 (0-6.5)	2.5 (0-6.2)	0.140
Tumor number, n (%)			0.404
0 or 1	58 (68.2)	21 (60.0)
2 or 3	27(31.8)	14 (40.0)
Tumor necrosis, n (%)	49 (58.3)	20 (57.1)	1.000
Lymphovascular invasion, n (%)	6 (7.1)	5 (14.3)	0.297
Outcomes
Hospital stays, median (range) (d)	21 (0-85)	18 (5-116)	0.810
HCC Recurrence, n (%)	16 (18.8)	15 (42.9)	0.011^a
Secondary cancer, n (%)	5 (6.4)	0	0.322
Mortality, n (%)	9 (10.6)	11 (31.4)	0.013^a

^aP < 0.05.

BMI: Body mass index; HBV: Hepatitis B virus; HCV: Hepatitis C virus; GRWR: Graft-to-recipient weight ratio; INR: International normalized ratio; MELD: The Model for End-stage Liver Disease; AFP: α-fetoprotein; LT: Liver transplantation; DDLT: Deceased donor liver transplantation; LDLT: Living donor liver transplantation; SLT: Split liver transplantation.

Table 2 Cox proportional hazard model for cancer-free survival

	Univariate		Multivariate
	Hazard ratio (95%CI)	P value	Hazard ratio (95%CI)	P value
Age	1.055 (1.001, 1.112)	0.047^a	1.057 (1.001, 1.117)	0.048^a
Gender/male	1.346 (0.614, 2.950)	0.459	-
BMI	0.937 (0.850, 1.033)	0.191	-
HBV	2.070 (1.005, 4.263)	0.048^a	1.371 (0.632, 2.978)	0.425
HCV	0.687 (0.332-1.423)	0.313	-
Alcoholism	1.751 (0.532-5.769)	0.357	-
Diabetes mellitus	1.062 (0.523, 2.157)	0.868	-
Hypertension	1.704 (0.777, 3.736)	0.183	-
Tumor size	1.057 (0.817, 1.368)	0.672	-
Tumor number (2/3 vs 0/1)	1.577 (0.777, 3.199)	0.207	-
Lymphovascular invasion	1.722 (0.600, 4.945)	0.312	-
Splenectomy	2.754 (1.359, 5.581)	0.005^a	2.560 (1.198, 5.471)	0.015^a
PLT	1.000 (1.000, 1.000)	0.579	-
AFP	1.001 (1.000, 1.002)	0.070	-

^aP < 0.05.

CI: Confidence interval; BMI: Body mass index; HBV: Hepatitis B virus; HCV: Hepatitis C virus; GRWR: Graft-to-recipient weight ratio; INR: International normalized ratio; MELD: The Model for End-stage Liver Disease; AFP: α-fetoprotein.

Table 3 Cox proportional hazard model for mortality

	Univariate		Multivariate
	Hazard ratio (95%CI)	P value	Hazard ratio (95%CI)	P value
Age	1.063 (0.994, 1.136)	0.075	-
Gender/male	1.424 (0.540, 3.757)	0.475	-
BMI	0.942 (0.834, 1.063)	0.333	-
HBV	4.386 (1.719, 11.193)	0.002^a	4.077 (1.001, 16.615)	0.050
HCV	2.853 (1.145, 7.114)	0.024^a	0.661 (0.166, 2.640)	0.558
Alcoholism	0.696 (0.161, 3.018)	0.629	-
Diabetes mellitus	1.640 (0.679, 3.958)	0.271	-
Hypertension	2.872 (1.142, 7.221)	0.025^a	2.813 (1.111, 7.123)	0.029^a
Tumor size	0.944 (0.679, 1.312)	0.732	-
Tumor number (2-3 vs 0-1)	1.911 (0.795, 4.596)	0.148	-
Lymphovascular invasion	2.054 (0.597, 7.062)	0.254	-
Splenectomy	3.656 (1.510, 8.848)	0.004^a	2.791 (1.081, 7.206)	0.034^a
PLT	1.000 (1.000, 1.000)	0.409	-
AFP	1.001 (1.000, 1.002)	0.081	-

^aP < 0.05.

Citation: Fan HL, Hsieh CB, Kuo SM, Chen TW. Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients. World J Gastrointest Surg 2022; 14(9): 930-939
URL: https://www.wjgnet.com/1948-9366/full/v14/i9/930.htm
DOI: https://dx.doi.org/10.4240/wjgs.v14.i9.930