Splenic steal syndrome

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.

Epidemiology

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.

Clinical presentation

Occurs in the early postoperative period and may present with elevated liver function tests.

Radiographic features

Ultrasound

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 ultrasoundangiography.

• hypoperfusion in the main, left, and right hepatic arteries (manifested as tardus et parvus waveforms)
  • some sources have reportedlow/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)

Angiography

• 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 embolization.