SPLENIC ARTERY EMBOLIZATION IN THE MANAGEMENT OF COMPLICATIONS AFTER ORTHOTOPIC LIVER TRANSPLANTATION
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.5758Keywords:
Liver Transplantation, Splenic Artery Embolization, Splenic Artery Steal Syndrome, Interventional Radiology, Splanchnic CirculationAbstract
Aim: The aim of this study is to present the role of splenic artery embolization (SAE) in the management of selected complications following orthotopic liver transplantation (OLTx), with particular emphasis on its clinical application.
Methods: A narrative literature review was conducted, including studies on post-OLTx complications and the use of interventional radiology techniques. Publications addressing the mechanisms underlying these complications and their management using SAE were analyzed.
Results: SAE is a minimally invasive endovascular procedure involving occlusion of blood flow within the splenic artery using embolic materials. It is applied in the treatment of selected complications after OLTx, including splenic artery steal syndrome, refractory ascites, and hypersplenism. By reducing blood flow within the splenic vascular bed, SAE improves arterial graft perfusion, decreases portal inflow, and modulates hemodynamic disturbances. Available data indicate high efficacy of this method in selected clinical settings.
Conclusion: SAE is an effective and minimally invasive method for the management of selected complications following OLTx. Its use in clinical practice is expected to increase with the growing role of minimally invasive techniques in post-transplant care.
References
Altaca, G., Yilmaz, S., Demirbas, A., et al. (1997). Persistent hypersplenism early after liver transplant: The role of splenectomy. Transplantation, 64(10), 1481–1483.
Chang, C. Y., Singh, N., Mekeel, K., et al. (2007). Use of splenic artery embolization to relieve tense ascites following liver transplantation in a patient with paroxysmal nocturnal hemoglobinuria. Liver Transplantation, 13(11), 1532–1537. https://doi.org/10.1002/lt.21317
Chezmar, J. L., Redvanly, R. D., Nelson, R. C., et al. (1992). Persistence of portosystemic collaterals and splenomegaly on CT after orthotopic liver transplantation. American Journal of Roentgenology, 159(2), 317–320. https://doi.org/10.2214/ajr.159.2.1632346
Cirera, I., Rimola, A., Navasa, M., et al. (2000). Ascites after liver transplantation. Liver Transplantation, 6(2), 157–162.
De Carlis, L., Sansalone, C. V., Rondinara, G. F., et al. (1993). Splenic artery steal syndrome after orthotopic liver transplantation: Diagnosis and treatment. Transplantation Proceedings, 25(4), 2594–2596.
Feng, A.-C., Fan, H.-L., Chen, T.-W., et al. (2014). Hepatic hemodynamic changes during liver transplantation: A review. World Journal of Gastroenterology, 20(32), 11131–11141. https://doi.org/10.3748/wjg.v20.i32.11131
Fleckenstein, F. N., et al. (2022). Splenic artery steal syndrome in patients with orthotopic liver transplant: Where to embolize the splenic artery? PLOS ONE, 17(3), e0263832. https://doi.org/10.1371/journal.pone.0263832
Harkins, J. M., & Ahmad, B. (2023). Anatomy, abdomen and pelvis, portal venous system (hepatic portal system). In StatPearls. StatPearls Publishing.
Hiatt, J. R., Gabbay, J., & Busuttil, R. W. (1994). Surgical anatomy of the hepatic arteries in 1000 cases. Annals of Surgery, 220(1), 50–52. https://doi.org/10.1097/00000658-199407000-00008
Jakab, F., et al. (1995). The interaction between hepatic arterial and portal venous blood flows; simultaneous measurement by transit time ultrasonic volume flowmetry. Hepato-Gastroenterology, 42(1), 18–21.
Jiang, J., et al. (2022). Splenic artery embolization for splenic artery steal syndrome after living donor liver transplantation: A case report. Transplantation Proceedings, 54(10), 2675–2678. https://doi.org/10.1016/j.transproceed.2022.09.020
Kim, J. H., et al. (2011). Effect of splenic artery embolization for splenic artery steal syndrome in liver transplant recipients: Estimation at computed tomography based on changes in caliber of related arteries. Transplantation Proceedings, 43(5), 1744–1748. https://doi.org/10.1016/j.transproceed.2011.02.079
Lautt, W. W. (1985). Mechanism and role of intrinsic regulation of hepatic arterial blood flow: Hepatic arterial buffer response. American Journal of Physiology-Gastrointestinal and Liver Physiology, 249(5), G549–G556. https://doi.org/10.1152/ajpgi.1985.249.5.G549
Lee, A. R. A. M., et al. (2017). Minimally invasive interventions for nontraumatic splenic disorders. Endovascular Today, 77–84.
Li, C., et al. (2017). Current understanding and management of splenic steal syndrome after liver transplant: A systematic review. Transplantation Reviews, 31(3), 188–192. https://doi.org/10.1016/j.trre.2017.02.002
Luca, A., et al. (2006). Effects of splenic artery occlusion on portal pressure in patients with cirrhosis and portal hypertension. Liver Transplantation, 12(8), 1237–1243. https://doi.org/10.1002/lt.20762
Manner, M., et al. (1991). Arterial steal: An unusual cause for hepatic hypoperfusion after liver transplantation. Transplant International, 4(2), 122–124. https://doi.org/10.1007/BF00336410
Obri, M. S., et al. (2023). Splenic artery embolism in liver transplant patients: A single-center experience. Cureus, 15(5), e38599. https://doi.org/10.7759/cureus.38599
Pandey, S. K., et al. (2004). Anatomical variations of the splenic artery and its clinical implications. Clinical Anatomy, 17(6), 497–502. https://doi.org/10.1002/ca.10220
Payen, D. M., et al. (1990). Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: Interest for early complications and nutrition. Surgery, 107(4), 417–427.
Pinto, S., Horow, M., & Ortiz, J. (2014). Splenic artery steal syndrome review. Transplantation, 98(Suppl), A410.
Presser, N., et al. (2015). Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients: A 5-year experience. Liver Transplantation, 21(4), 435–441. https://doi.org/10.1002/lt.24081
Quintini, C., et al. (2008). “Splenic artery steal syndrome” is a misnomer: The cause is portal hyperperfusion, not arterial siphon. Liver Transplantation, 14(3), 374–379. https://doi.org/10.1002/lt.21352
Quintini, C., et al. (2011). Splenic artery embolization for the treatment of refractory ascites after liver transplantation. Liver Transplantation, 17(6), 668–673. https://doi.org/10.1002/lt.22272
Rysmakhanov, M., et al. (2015). Splenic artery embolization in patients after orthotopic liver transplant. Experimental and Clinical Transplantation, 13(Suppl 3), 52–54. https://doi.org/10.6002/ect.tdtd2015.O43
Settmacher, U., et al. (2000). Arterial complications after liver transplantation. Transplant International, 13(5), 372–378. https://doi.org/10.1007/s001470050716
Uflacker, R., et al. (2002). Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation. Cardiovascular and Interventional Radiology, 25(4), 300–306. https://doi.org/10.1007/s00270-001-0082-4
Usai, S., et al. (2022). Splenic artery steal syndrome after liver transplantation—Prophylaxis or treatment? A case report and literature review. Annals of Hepato-Biliary-Pancreatic Surgery, 26(4), 386–394. https://doi.org/10.14701/ahbps.22-004
Vogl, T. J., et al. (2001). Arterial steal syndrome in patients after liver transplantation: Transarterial embolization of the splenic and gastroduodenal arteries. RöFo, 173(10), 908–913. https://doi.org/10.1055/s-2001-17592
Wehrle, C. J., et al. (2025). Mechanisms and management of graft inflow and outflow in liver transplantation. Journal of Hepatology (in press).
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Marcin Sękulski, Martyna Mrozek , Igor Zydlewski , Małgorzata Blecharczyk, Martyna Pacanowska-Trawnicka, Paweł Jakubiec
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
