Introduction: Splenectomy is performed in living donor liver transplantation (LDLT) for portal flow modulation. The aim of this study was to identify the risk factor of 6-month graft mortality in patients who underwent splenectomy in LDLT.

Methods: Data from 441 adult patients who underwent simultaneous splenectomy during primary LDLT were collected retrospectively. Risk factors of 6-month graft mortality were investigated.

Results: Mean recipient age was 55 years. Mean donor age was 38.7 years. Two hundred and five patients (46.5%) received left lobe graft. Mean graft weight (GW)-standard liver weight ratio was 41.5% and GW-recipient weight ratio was 0.79%. Six-month graft survival rate after LDLT in 441 patients was 93.8%, which was significantly better compared to patients without simultaneous splenectomy or splenic artery ligation (83.9%, p<0.0001). Univariate analysis revealed the following risk factors for 6-month graft mortality in patients with splenectomy: neutrophil-lymphocyte ratio > 4, acute liver failure, hospitalized before LDLT, donor > 60 years of age, MELD score > 22, pre-LDLT platelet < 40, 000/mm3, portal vein pressure when LDLT finished (PVP) > 20 mmHg. Multivariate analysis identified that donor > 60 years of age (Hazard ratio=4.50, p=0.049), pre-LDLT platelet < 40, 000/mm3 (Hazard ratio=2.58, p=0.03), and PVP > 20 mmHg (Hazard ratio=7.46, p<0.001) were the independent risk factors of 6-month graft mortality after LDLT.

Conclusion: Splenectomy in LDLT improves survival rate after LDLT. Careful attention is needed for patients with platelet < 40, 000/mm3, PVP > 20 mmHg, and received graft from donor > 60 years of age.