Splenohepatic and gastroduodenal steal syndrome in liver transplant recipients

The study describes a syndrome, the splenohepatic and gastroduodenal steal syndrome, demonstrable by angiography in 18 patients before and after liver transplantation. Following the initial observation of a splenohepatic steal syndrome in a patient with unexplained elevation of hepatic enzymes after liver transplantation a prospective angiography study was performed which included all liver transplant recipients and patients after liver transplantation with unexplained impaired liver function tests and a hypersplenism with thrombo- and leucocytopenia. Ten steal syndromes were demonstrated before and eight after hepatic transplantation. The therapeutic modalities, including splenic artery embolization with secondary splenectomy and splenectomy without prior embolization, resulting in a normalisation of the liver function tests, are discussed.