Pediatric Transplantation, cilt.29, sa.7, 2025 (SCI-Expanded)
Background: Biliary atresia (BA) is the most common cause of liver transplantation (LT) in children. Despite a successful Kasai procedure, liver cirrhosis develops in half of the patients in the first 2 years of life. Hypersplenism secondary to cirrhosis causes cytopenias, immune dysregulation, and increased intra-abdominal pressure. LT reduces hypersplenism complications due to normalized portal pressure. In cases with normal liver function but severe hypersplenism, interventions are needed before or simultaneous with LT, despite the possible negative effects of splenic interventions on graft perfusion and, thus, function. Methods: Here, we present a 23-month-old boy with BA and hypersplenism symptoms despite a normally functional liver. Using cases from the literature, we discussed the advantages and disadvantages of hypersplenism management in the peritransplantation period with our patient. Results: Interventions like splenectomy and splenic artery ligation (SAL) to reduce hypersplenism-related complications can be performed in the pre- and/or post-transplantation period. Conclusions: Necessary interventions should be personalized for each patient according to their clinical conditions and possible issues.