Targeting spleen for the treatment of liver cirrhosis

[Marwan76]

Hi . any one has experience or hear about Targeting spleen for the treatment of liver cirrhosis ? this is of course only for liver cirrhosis patient with splenomegaly

[AyrshireK]

I am not quite sure what your mean about targeting spleen.

My hubby had splenomegaly due to cirrhosis - his spleen was 19.5cm but wasn't causing issues apart from reduced platelet count and increased blood clotting time. He also had portal hypertension and had endured 42 variceal bands.

During his CT scan at liver transplant assessment they discovered he also had numerous aneurysms in his splenic artery due to portal hypertension so after t/p assessment he underwent a embolization operation to deal with the numerous aneurysms, in doing so he ended up suffering a partial splenic infarction (his spleen died, shrivelled up and is now under 10cm).

His spleen is deemed non-viable so he has to take Phenoxymethyl Penicillin for life to support spleen function.

It was painful at the time as his spleen died HOWEVER it had a knock on positive effect on his liver. His platelet count improved, blood clotting time normalized and even the portal hypertension is gone.

All these improvements led to him being able to be removed from the transplant list. When he was undergoing the procedure we discovered that in some countries partial splenic embolization is actually purposefully done to treat splenomegaly and improve cirrhotic liver function. ncbi.nlm.nih.gov/pmc/articl...

I don't know if this is what you mean by the targeting spleen but the procedure my hubby had has certainly prolonged his liver - it is now 5 years since he was taken off the liver transplant list.

Katie

[Marwan76 in reply to AyrshireK]

Nice Reply , thanks a lot Katie , but only you might want to know something else about this subject . in fact PSE or Splenectomy or treatment of splenomegaly by medicine not only improve the overall Health of the liver for it is positive rule in portal hypertension , varices

the new thing i have recently knew that the Splenic contributions to hepatic fibrogenesis

and liver cirrhosis , it is closed circuit

translational-medicine.biom...

just want to ask a question , when the doctors intended to do the embolization operation , they did intentionally aiming to improve the liver health or only to deal with numerous aneurysms of his spleen

[AyrshireK in reply to Marwan76]

We were told if his aneurysms had burst it would have been fatal, they had to be dealt with before he could go forward to transplant as it was an added complication if transplant had happened so we were not told of the possible effect of killing the spleen. I think it was primarily done to treat the aneurysms but the infarction has obviously improved things with the liver.

Certainly now no portal hypertension, increased platelets, better INR, gained body weight well and 10 months after listed he was delisted from tranpslant list and continues to be stable.

Katie

[cammeag in reply to AyrshireK]

Hi Katie, why haven’t researchers picked up on this. Surely if what happened to hubby is true, then removal of spleen should be done without question in advanced cirhossis?

[AyrshireK in reply to cammeag]

If you type 'partial splenic embolisation for cirrhosis' into your search engine you'll find that this procedure is used in other countries to treat portal hypertension and as above in the link I provided to treat cirrhosis.

In my hubbies case what I have reported is 100% accurate. He was assessed for transplant in June 2014 with the decision to list once his aneurysms were dealt with. Up to that point he was having banding every 5-8 weeks or so.

He had the embolization and was then listed. The splenic infarction led to horrendous pain including agonizing referred left shoulder pain for a good few months. CT scan indicated he had lost much of his spleen and it is now deemed non-viable and he requires to take penicillin V for life to support his spleen - obviously this places him at some increased risk with infections. However, his platelet count rose in weeks from only 20 to 200 and his INR normalized. All subsequent ultrasound scans have revealed normal portal veinous flow, no portal hypertension and no further banding required since the embolization.

He was delisted from the transplant list in May 2015.

Katie

[Supportinghubby in reply to AyrshireK]

This is really interesting. I know you've mentioned this in a reply to me before. It seems (to inexperienced me) that a lot of his problems are due to his enlarged spleen - low platelets etc. Something to discuss at his next appointment.

[AyrshireK in reply to Supportinghubby]

Puzzled by your reply, my hubby no longer has an enlarged spleen - that's been the point of my replies above. These issues were before my hubby had his splenic artery aneursyms dealt with by embolization and as a result his issues receded he now has normal platelets, normal blood clotting, a shrunken and partially infarcted spleen. (or is it your hubby you are meaning?)

[Supportinghubby in reply to AyrshireK]

Sorry, I didn't phrase that properly, yes, I meant my husband's enlarged spleen not your husband's (as I know yours doesn't have one anymore!)

[AyrshireK in reply to Supportinghubby]

Most people with cirrhosis do end up with an enlarged spleen with the knock on effect of low platelets, increased blood clotting time etc.

[Supportinghubby in reply to AyrshireK]

Yes I know - that's why I'm interested in this thread about embolism being used to treat portal hypertension in other countries & in your husband's experience. My husband now attends a nurse-led clinic so I'm not sure how much they'll know about it and I don't expect it to be an option as it doesn't seem to be done in this country for this purpose, but still interested to discuss it.

[Kristian]

Nope, never heard of that.