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Splenic artery steal syndrome after liver transplantation – prophylaxis or treatment?: A case report and literature review
Ann Hepatobiliary Pancreat Surg
Published online August 1, 2022;
Copyright © 2022 The Korean Association of Hepato-Biliary-Pancreatic Surgery.

Sofia Usai1, Marco Colasanti2, Roberto Luca Meniconi2, Stefano Ferretti2, Nicola Guglielmo2, Germano Mariano2, Giammauro Berardi2, Matteo Cinquepalmi3, Marco Angrisani2, Giuseppe Maria Ettorre2

1Department of Surgical Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy,
2General Surgery and Organ Transplantation Unit, San Camillo-Forlanini Hospital, Rome, Italy,
3Department of General Surgery, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
Correspondence to: Sofia Usai
Department of Surgical Sciences, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
Tel: +39-3474937852, Fax: +39-0658705212, E-mail:
Received January 18, 2022; Revised March 9, 2022; Accepted March 10, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Splenic artery steal syndrome (SASS) is a cause of graft hypoperfusion leading to the development of biliary tract complications, graft failure, and in some cases to retransplantation. Its management is still controversial since there is no universal consensus about its prophylaxis and consequently treatment. We present a case of SASS that occurred 48 hours after orthotopic liver transplantation (OLTx) in a 56-year-old male patient with alcoholic cirrhosis and severe portal hypertension, and who was successfully treated by splenic artery embolization. A literature search was performed using the PubMed database, and a total of 22 studies including 4,789 patients who underwent OLTx were relevant to this review. A prophylactic treatment was performed in 260 cases (6.2%) through splenic artery ligation in 98 patients (37.7%) and splenic artery banding in 102 (39.2%). In the patients who did not receive prophylaxis, SASS occurred after OLTx in 266 (5.5%) and was mainly treated by splenic artery embolization (78.9%). Splenic artery ligation and splenectomies were performed, respectively, in 6 and 20 patients (2.3% and 7.5%). The higher rate of complications registered was represented by biliary tract complications (9.7% in patients who received prophylaxis and 11.6% in patients who developed SASS), portal vein thrombosis (respectively, 7.3% and 6.9%), splenectomy (4.8% and 20.9%), and death from sepsis (4.8% and 30.2%). Whenever possible, prevention is the best way to approach SASS, considering all the potential damage arising from an arterial graft hypoperfusion. Where clinical conditions do not permit prophylaxis, an accurate risk assessment and postoperative monitoring are mandatory.
Keywords : Splenic artery steal syndrome; Graft hypoperfusion; Nonocclusive hepatic artery hypoperfusion; Steal syndrome


August 2022, 26 (3)
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