Splenic Embolization in the Management of Complications after Liver Transplantation: Integrative Review

Authors

Keywords:

Splenic Artery, Liver Transplantation, Embolization, Therapeutic

Abstract

Introduction:  Liver transplantation is a definitive treatment for patients with end-stage liver disease and liver neoplasms. Vascular complications remain an important cause of morbidity and mortality in these patients. Splenic artery embolization is an alternative to improve the clinical and hemodynamic conditions of such patients. Methods:  The research was conducted in October 2025 on the PubMed and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) platforms, based on the descriptors: “Splenic artery,” “Embolization, therapeutic,” and “Liver Transplantation”; 15 articles were selected based on eligibility criteria. Results:  Seven case reports and eight cohort studies, or retrospective case series were found, reflecting the current level of evidence on the application of splenic artery embolization in patients undergoing liver transplantation. Analysis of the articles allowed the data to be synthesized into three central thematic categories: indications for the procedure, techniques used, and clinical outcomes, including complications. Conclusion:  Splenic artery embolization is a minimally invasive, safe, and effective therapeutic strategy for the management of selected complications after liver transplantation, such as splenic artery steal syndrome, refractory ascites, hydrothorax, and hypersplenism.

 

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References

1. Rysmakhanov M, Doskali M, Taganova A, Kulmagambetov A, Smagulov A, Seidakhmetov A, et al. Splenic artery embolization in patients after orthotopic liver transplant. Exp Clin Transplant, 2015; 13 (Suppl. 3): 52-4. https://doi.org/10.6002/ect.tdtd2015.O43

2. Lee CY, Lim WX, Chen CL, Yong CC, Yu CY, Tsang LL, et al. Efficacy and safety of splenic artery embolization for intractable ascites using Amplatzer vascular plug versus coil after living donor liver transplantation. Diagn Interv Radiol, 2022; 28(5): 478-85. https://doi.org/10.5152/dir.2022.21027

3. Fleckenstein FN, Luedemann WM, Kücükkaya A, Auer TA, Plewe J, Hamm B, et al. Splenic artery steal syndrome in patients with orthotopic liver transplant: where to embolize the splenic artery? PLOS ONE, 2025; 17(3): e0263832. https://doi.org/10.1371/journal.pone.0263832

4. DuBois B, Mobley D, Chick JF, Srinivasa RN, Wilcox C, Weintraub J. Efficacy and safety of partial splenic embolization for hypersplenism in pre- and post-liver transplant patients: a 16-year comparative analysis. Clin Imaging, 2019; 54: 71-7. https://doi.org/10.1016/j.clinimag.2018.11.012

5. D’Amico G, Partovi S, Del Prete L, Matsushima H, Diago-Uso T, Hashimoto K, et al. Proximal splenic artery embolization for refractory ascites and hydrothorax post-liver transplant. Cardiovasc Interv Radiol, 2023; 46. https://doi.org/10.1007/s00270-023-03376-3

6. Livingston AJ, Hickman L, Imani RA, Alexopoulos SP, Matsuoka L. Noninvasive management of complications from splenic artery aneurysm embolization after liver transplant: a case report. Exp Clin Transplant, 2021; 20(2). https://doi.org/10.6002/ect.2020.0531

7. Jiang J, Ji Y, Liang Y, Ou Y, Zhang L. Splenic artery embolization for splenic artery steal syndrome after living donor liver transplantation: a case report. Transplant Proc, 2022; 54(10). https://doi.org/10.1016/j.transproceed.2022.09.020

8. Pravisani R, Baccarani U, Adani G, Lorenzin D, Vit A, Cherchi V, et al. Splenic artery syndrome as a possible cause of late onset refractory ascites after liver transplantation: management with proximal splenic artery embolization. Transplant Proc, 2016; 48(2): 377-9. https://doi.org/10.1016/j.transproceed.2016.01.013

9. Okabe H, Yoshizumi T, Ikegami T, Uchiyama H, Harimoto N, Itoh S, et al. Salvage splenic artery embolization for saving falling living donor graft due to portal overflow: a case report. Transplant Proc, 2016; 48(9): 3171-3. https://doi.org/10.1016/j.transproceed.2016.07.023

10. Meighani A, Jafri SM, Raoufi M, Salgia R. Splenic artery embolization for treatment of refractory ascites after liver transplantation. ACG Case Rep J, 2016; 3(2): 136-8. Available at https://doi.org/10.14309/crj.2016.25

11. Maki H, Kaneko J, Arita J, Akamatsu N, Sakamoto Y, Hasegawa K, et al. Proximal total splenic artery embolization for refractory hepatic encephalopathy. Clin J Gastroenterol, 2017; 11(2): 156-60. https://doi.org/10.1007/s12328-017-0805-5

12. Liu DY, Yi ZJ, Tang Y, Niu NN, Li JX. Three case reports of splenic artery steal syndrome after liver transplantation. Transplant Proc, 2015; 47(10): 2939-43. https://doi.org/10.1016/j.transproceed.2015.10.037

13. Teegen EM, Denecke T, Schmuck RB, Öllinger R, Geisel D, Pratschke J, et al. Impact of Doppler ultrasound on diagnosis and therapy control of lienalis steal syndrome after liver transplantation. Ann Transplant, 2017; 22: 440-5. https://doi.org/10.12659/aot.903526

14. Nutu OA, Justo Alonso I, Marcacuzco Quinto AA, Calvo Pulido J, Jiménez Romero LC. Complete splenic embolization for the treatment of refractory ascites after liver transplantation. Rev Espanola Enfermedades Dig, 2018; 110(4). https://doi.org/10.17235/reed.2018.5338/2017

15. Bulman JC, Weinstein JL, Moussa M, Ahmed M. Transsplenic arterial embolization for splenic artery steal following liver transplant. J Vasc Interv Radiol, 2021; 32(3): 474-5. https://doi.org/10.1016/j.jvir.2020.11.013

Published

2026-02-13

How to Cite

1.
Konrath AP, Maia GL, Fonseca Neto OCL da. Splenic Embolization in the Management of Complications after Liver Transplantation: Integrative Review. bjt [Internet]. 2026 Feb. 13 [cited 2026 Feb. 14];29. Available from: https://bjt.emnuvens.com.br/revista/article/view/759

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Section

Review Article