Splenic steal syndrome is a possible complication after liver transplantation. In this syndrome, blood flows preferentially from the celiac artery into the splenic artery and the hepatic artery is relatively hypoperfused as a result. This complication can threaten a liver transplant's survival.
The incidence of splenic steal syndrome is uncertain since there are no clear imaging criteria. It has been estimated at somewhere between 0.6-10.1% of liver transplants 1.
Occurs in the early postoperative period and may present with elevated liver function tests.
There are no specific ultrasound criteria for splenic steal syndrome at this time. Instead, Doppler ultrasound findings in the correct clinical setting may suggest the diagnosis and lead to follow up confirmatory angiography.
- hypoperfusion in the main, left, and right hepatic arteries (manifested as low/absent diastolic flow and a high RI (>0.80)
- no evidence of hepatic artery stenosis
- increased velocity in the splenic artery (at least above 100-115 cm/s)
- injection of the celiac axis will show clearly preferential flow into the splenic artery and little contrast into the hepatic artery
Treament and prognosis
Splenic steal syndrome can be treated with splenic embolisation.
- 1. Saad WE. Nonocclusive hepatic artery hypoperfusion syndrome (splenic steal syndrome) in liver transplant recipients. Semin Intervent Radiol. 2012;29 (02): 140-6. doi:10.1055/s-0032-1312576 - Free text at pubmed - Pubmed citation
- 2. Nüssler NC, Settmacher U, Haase R et-al. Diagnosis and treatment of arterial steal syndromes in liver transplant recipients. Liver Transpl. 2003;9 (6): 596-602. doi:10.1053/jlts.2003.50080 - Pubmed citation
- 3. Sevmis S, Boyvat F, Aytekin C et-al. Arterial steal syndrome after orthotopic liver transplantation. Transplant. Proc. 2006;38 (10): 3651-5. doi:10.1016/j.transproceed.2006.10.145 - Pubmed citation