Splenic artery syndrome after orthotopic liver transplantation: A review

•We summarize the pathophysiology and epidemiology of Splenic Artery Syndrome (SAS).•We discuss the clinical, laboratory, and diagnostic features commonly seen in SAS.•We review treatment options for SAS that have been performed to date.•We summarize current data regarding the utility of prophylaxis for SAS.

Splenic Artery Syndrome (SAS) has emerged as a controversial cause for graft ischemia in orthotopic liver transplant (OLTx) recipients. A complex combination of factors including hepatic artery hypoperfusion and portal hyperperfusion can result in SAS. Clinical and laboratory findings suggest graft ischemia but are generally non-specific. Conventional angiography findings of hepatic artery hypoperfusion with early and rapid filling of the splenic artery are suggestive of the diagnosis in the appropriate clinical setting. Treatment involves proximal splenic artery embolization, surgical splenic artery ligation, or in extreme cases, splenectomy. Most patients with SAS improve clinically following treatment. However, no randomized control trials are available to compare treatment options. Identification of at risk patients with pre-operative CT scans and intra-operative ultrasound has been proposed by some and may allow for prophylactic treatment of SAS.