{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:55:11Z","timestamp":1790150111572,"version":"4.0.1"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>This study compared proximal and distal embolization of the splenic artery (SA) in patients with splenic artery steal syndrome (SAS) after orthotopic liver transplantation (OLT) regarding post interventional changes of liver function to identify an ideal location of embolization.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and materials<\/jats:title>\n<jats:p>85 patients with SAS after OLT treated with embolization of the SA between 2007 and 2017 were retrospectively reviewed. Periinterventional DSA was used to assess treatment success and to stratify patients according to the site of embolization. Liver function was assessed using following laboratory values: bilirubin, albumin, gamma-glutamyl transferase, glutamat-pyruvat-transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), Alkaline Phosphatase (ALP), aPTT, prothrombin time and thrombocyte count. Descriptive statistics were used to summarize the data. Median laboratory values of pre, 1- and 3-days, as well as 1-week and 1-month post-embolization were compared between the respective embolization sites using linear mixed model regression analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>All procedures were technically successful and showed an improved blood flow in the hepatic artery post-embolization. Ten Patients were excluded due to re -intervention or inconsistent image documentation. Pairwise comparison using linear mixed model regression analysis showed a significant difference between proximal and distal embolization for GPT (57.0 (IQR 107.5) vs. 118.0 (IQR 254.0) U\/l, p = 0.002) and GOT (48.0 (IQR 48.0) vs. 81.0 (IQR 115.0) U\/l, p = 0.008) 3-days after embolization as well as median thrombocyte counts 7-days after embolization (122 (IQR 108) vs. 83 (IQR 74) in thousands, p = 0.014). For all other laboratory values, no statistically significant difference could be shown with respect to the embolization site.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>We conclude that long-term outcomes after embolization of the SA in the scenario of SAS after OLT are irrespective of the site of embolization of the SA, whereas a proximal embolization potentially facilitates earlier normalization of liver function. Choice of technique should therefore be informed by anatomical conditions, safety considerations and preferences of the interventionalist.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0263832","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T18:34:32Z","timestamp":1646937272000},"page":"e0263832","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Splenic artery steal syndrome in patients with orthotopic liver transplant: Where to embolize the splenic artery?"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1088-1721","authenticated-orcid":true,"given":"Florian N.","family":"Fleckenstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4255-1009","authenticated-orcid":true,"given":"Willie M.","family":"Luedemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"K\u00fcc\u00fckkaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo A.","family":"Auer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Plewe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Hamm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf W.","family":"G\u00fcnther","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uli","family":"Fehrenbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Gebauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gero","family":"Wieners","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"issue":"4","key":"pone.0263832.ref001","first-page":"2594","article-title":"Splenic artery steal syndrome after orthotopic liver transplantation: diagnosis and treatment","volume":"25","author":"L De Carlis","year":"1993","journal-title":"Transplant Proc"},{"issue":"6","key":"pone.0263832.ref002","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1053\/jlts.2003.50080","article-title":"Diagnosis and treatment of arterial steal syndromes in liver transplant recipients","volume":"9","author":"NC Nussler","year":"2003","journal-title":"Liver Transpl"},{"issue":"5","key":"pone.0263832.ref003","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1111\/j.1432-2277.2000.tb01012.x","article-title":"Arterial complications after liver transplantation","volume":"13","author":"U Settmacher","year":"2000","journal-title":"Transpl Int"},{"issue":"10","key":"pone.0263832.ref004","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1055\/s-2001-17592","article-title":"Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries","volume":"173","author":"TJ Vogl","year":"2001","journal-title":"Rofo"},{"issue":"4","key":"pone.0263832.ref005","doi-asserted-by":"crossref","first-page":"657","DOI":"10.2214\/ajr.147.4.657","article-title":"Vascular complications after liver transplantation: a 5-year experience","volume":"147","author":"P Wozney","year":"1986","journal-title":"AJR Am J Roentgenol"},{"issue":"11","key":"pone.0263832.ref006","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.ijsu.2014.09.012","article-title":"Splenic Artery Syndrome after orthotopic liver transplantation: a review","volume":"12","author":"S Pinto","year":"2014","journal-title":"Int J Surg"},{"issue":"4","key":"pone.0263832.ref007","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/s00270-002-2614-5","article-title":"Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation","volume":"25","author":"R Uflacker","year":"2002","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"2\u20133","key":"pone.0263832.ref008","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1432-2277.2002.tb00141.x","article-title":"Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management","volume":"15","author":"I Geissler","year":"2002","journal-title":"Transpl Int"},{"issue":"4","key":"pone.0263832.ref009","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.transproceed.2007.02.024","article-title":"Multidetector computed tomographic angiography findings of splenic artery steal syndrome in liver transplantation","volume":"39","author":"I Kirbas","year":"2007","journal-title":"Transplant Proc"},{"issue":"5","key":"pone.0263832.ref010","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1016\/j.transproceed.2011.02.022","article-title":"Effect of splenic artery embolization for splenic artery steal syndrome in liver transplant recipients: estimation at computed tomography based on changes in caliber of related arteries","volume":"43","author":"JH Kim","year":"2011","journal-title":"Transplant Proc"},{"issue":"6","key":"pone.0263832.ref011","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1007\/s00270-010-0083-9","article-title":"Splenic artery syndrome after orthotopic liver transplantation: treatment with the Amplatzer vascular plug","volume":"34","author":"MH Maurer","year":"2011","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"8","key":"pone.0263832.ref012","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/j.1432-2277.2010.01062.x","article-title":"Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation","volume":"23","author":"MT Mogl","year":"2010","journal-title":"Transpl Int"},{"issue":"6","key":"pone.0263832.ref013","first-page":"1662","article-title":"Relationship between hepatic blood flow and overall metabolism: the hepatic arterial buffer response","volume":"42","author":"WW Lautt","year":"1983","journal-title":"Fed Proc"},{"issue":"Pt 1","key":"pone.0263832.ref014","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1469-7793.2001.0193j.x","article-title":"Hepatic arteriolo-portal venular shunting guarantees maintenance of nutritional microvascular supply in hepatic arterial buffer response of rat livers","volume":"531","author":"S Richter","year":"2001","journal-title":"J Physiol"},{"issue":"5","key":"pone.0263832.ref015","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.jvir.2007.11.025","article-title":"Evaluation of the Amplatzer vascular plug for proximal splenic artery embolization","volume":"19","author":"DM Widlus","year":"2008","journal-title":"J Vasc Interv Radiol"},{"issue":"3","key":"pone.0263832.ref016","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1007\/s00270-010-9957-0","article-title":"Utility of the Amplatzer Vascular Plug in splenic artery embolization: a comparison study with conventional coil technique","volume":"34","author":"X Zhu","year":"2011","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"3","key":"pone.0263832.ref017","doi-asserted-by":"crossref","first-page":"831","DOI":"10.2214\/ajr.181.3.1810831","article-title":"Significance of and contributing factors for a high resistive index on Doppler sonography of the hepatic artery immediately after surgery: prognostic implications for liver transplant recipients","volume":"181","author":"A Garcia-Criado","year":"2003","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"pone.0263832.ref018","first-page":"55","article-title":"The splenic steal syndrome and the gastroduodenal steal syndrome in patients before and after liver transplantation","volume":"2","author":"R Langer","year":"1992","journal-title":"Aktuelle Radiol"},{"issue":"5","key":"pone.0263832.ref019","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/00005373-199511000-00004","article-title":"Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis","volume":"39","author":"SJ Sclafani","year":"1995","journal-title":"J Trauma"},{"issue":"11","key":"pone.0263832.ref020","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1056\/NEJM197509112931105","article-title":"Platelet physiology and abnormalities of platelet function (first of two parts)","volume":"293","author":"HJ Weiss","year":"1975","journal-title":"N Engl J Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263832","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T18:34:50Z","timestamp":1646937290000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263832"}},"subtitle":[],"editor":[{"given":"Pavel","family":"Strnad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0263832","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,10]]}}}