Long-Term Efficacy of Partial Splenic Embolization in Children By Masaki Nio, Yutaka Hayashi, Nobuyuki Sano, Tomohiro Ishii, Hideyuki Sasaki, and Ryoji Ohi Sendai, Japan Purpose: To elucidate the role of partial splenic embolization (PSE) procedures, long-term outcome was assessed in terms of the recurrence of thrombocytopenia. Methods: A retrospective study was performed after 41 PSE procedures in 36 patients for hypersplenism owing to portal hypertension. The underlying disease was biliary atresia in 32 patients, extrahepatic portal obstruction in 3, and idio- pathic cirrhosis in 1. Results: The average volume embolized was 70.1%. The patients were followed up from 20 days to 182 months (average, 70.8 months). Five patients subsequently died, and 6 underwent liver transplantation. The causes of death or the reasons for liver transplantation were not related to hyper- splenism. Eleven patients (30.6%) had recurrence of throm- bocytopenia (100,000/mm 3 ). There was no significant dif- ference in the volume embolized or platelet count before PSE between the patients with and without recurrence of throm- bocytopenia. The peak value of platelet count after PSE was significantly lower in the patients with recurrence of throm- bocytopenia (P = .0091). In 17 of 24 survivors without liver transplantation, platelet counts remained normal throughout the follow-up period. Conclusions: PSE is a safe and effective procedure. Hemato- logic indices improved in all 36 patients after PSE, and its long-term efficacy was shown in 70% of the survivors. J Pediatr Surg 38:1760-1762. © 2003 Elsevier Inc. All rights reserved. INDEX WORDS: Partial splenic embolization, portal hyper- tension, hypersplenism, biliary atresia. H YPERSPLENISM is one of the major complica- tions of portal hypertension. Splenectomy had been a treatment of choice for severe hypersplenism owing to portal hypertension, but because of the risk of overwhelming sepsis after splenectomy, partial splenic embolization (PSE) has been used widely in patients with severe hypersplenism especially in small children. However, long-term efficacy of PSE is still unknown. In this report, we assessed retrospectively the long-term outcome of patients who underwent PSE. MATERIALS AND METHODS From 1984 to 2001, 36 patients underwent a total of 41 PSE procedures in Tohoku University Hospital. PSE was performed 3 times in 1 patient, twice in 3, and once in the remaining 32 patients. The indications for PSE in our institution were as follows: (1) the patient had splenomegaly caused by hypersplenism secondary to portal hyper- tension; (2) platelet counts were less than 100,000/mm 3 with ongoing thrombocytopenia; (3) the patient had bleeding complications such as epistaxis and gastrointestinal bleeding. We performed PSE in 36 patients who fulfilled all 3 of these criteria. The 36 patients (16 boys and 20 girls) underwent initial PSE at an average age of 7.9 years (range, 15 months to 22 years). The mean follow-up period after PSE ranged between 2 months and 15 years (average, 5.9 years). The underlying diseases were biliary atresia in 32, extrahepatic portal obstruction in 3, and idiopathic liver cirrhosis in the remaining 1 patient. Our previously reported PSE procedures were basically the same as that described by Spigos et al. 1,2 The percentage of embolized volume was precisely evaluated using technetium 99m Sn colloid splenic scintigram. Follow-up periods, embolized volumes, and the changes in platelet counts were compared between the groups with and without recurrence of thrombocytopenia (100,000/mm 3 ). The requirements for a second PSE and liver transplantation and the clinical outcome of each patient were also assessed. In the statistical analysis,  2 test for categorical variables and Mann-Whitney test for continuous variables were used, and a P value less than .05 was considered statistically significant. RESULTS Of the 36 patients, 11 (30.6%) had recurrence of thrombocytopenia after the first PSE. The mean fol- low-up period was essentially the same between groups with and without recurrence of thrombocytopenia (5.9 years). The percent embolized splenic volume was not statis- tically different between patients with and without recur- rence of thrombocytopenia (68% v. 71%, not significant). Platelet counts before PSE in patients with and without recurrence of thrombocytopenia were 61,200/mm 3 and 62,600/mm, 3 respectively (not significant). The platelet counts significantly increased after PSE in all patients. From the Department of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan. Presented at the 36th Annual Meeting of the Pacific Association of Pediatric Surgeons, Sydney, Australia, May 12-16, 2003. Address reprint requests to Masaki Nio, MD, Department of Pedi- atric Surgery, Tohoku University School of Medicine, 1-1, Seiryoma- chi, Aobaku, Sendai, 980-8574, Japan. © 2003 Elsevier Inc. All rights reserved. 0022-3468/03/3812-0015$30.00/0 doi:10.1016/j.jpedsurg.2003.08.050 1760 Journal of Pediatric Surgery, Vol 38, No 12 (December), 2003: pp 1760-1762