<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1130-0108</journal-id>
<journal-title><![CDATA[Revista Española de Enfermedades Digestivas]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. esp. enferm. dig.]]></abbrev-journal-title>
<issn>1130-0108</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Patología Digestiva]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1130-01082018000400011</article-id>
<article-id pub-id-type="doi">10.17235/reed.2018.5338/2017</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Embolización esplénica completa como tratamiento de la ascitis refractaria postrasplante]]></article-title>
<article-title xml:lang="en"><![CDATA[Complete splenic embolization for the treatment of refractory ascites after liver transplantation]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nutu]]></surname>
<given-names><![CDATA[Oana-Anisa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alonso]]></surname>
<given-names><![CDATA[Iago-Justo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marcacuzco-Quinto]]></surname>
<given-names><![CDATA[Alberto-Alejandro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Calvo-Pulido]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jiménez-Romero]]></surname>
<given-names><![CDATA[Luis-Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Universitario 12 de Octubre Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Complutense de Madrid Facultad de Medicina Departamento de Cirugía]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2018</year>
</pub-date>
<volume>110</volume>
<numero>4</numero>
<fpage>257</fpage>
<lpage>259</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1130-01082018000400011&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1130-01082018000400011&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1130-01082018000400011&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN La ascitis refractaria es una complicación infrecuente que puede aparecer en el posoperatorio de un trasplante hepático y cuyo diagnóstico y tratamiento suponen un verdadero reto. Presentamos dos casos de pacientes trasplantados por cirrosis criptogénica y que en el posoperatorio inmediato cursaron con ascitis refractaria, una complicación grave que se asocia con una disminución de la supervivencia de hasta un año y afecta la calidad de vida del paciente. Tras descartar las principales causas de ascitis en nuestros pacientes, se propuso como etiología el hiperaflujo portal, una condición que se perpetúa con la circulación esplénica y que condiciona una reducción del flujo arterial hepático. Por tanto, si se consigue disminuir el aflujo arterial al bazo, disminuyen el retorno venoso y la circulación portal, mejorando el flujo arterial. Con la embolización esplénica, procedimiento que surgió hace varios años como tratamiento al fenómeno del robo de la arteria esplénica y en los casos de "small for size" en el trasplante de donante vivo, se pretende disminuir el hiperaflujo portal y, por tanto, la ascitis. En conclusión, la embolización de arteria esplénica es una opción terapéutica como tratamiento de la ascitis refractaria en el postrasplante hepático.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Refractory ascites is an uncommon complication that may develop postoperatively after liver transplantation. The diagnosis and treatment of this condition is a real challenge. We report two cases of patients who underwent a transplant due to cryptogenic cirrhosis and developed refractory ascites during the immediate postoperative period. This is a serious complication associated with decreased survival by up to one year and a reduced quality of life. After ruling out the main causes of ascites, a portal hyperflow was a potential etiology. This condition perpetuates itself with splenic circulation and brings about a reduction in the hepatic arterial flow. Therefore, if arterial blood flow to the spleen is diminished, venous return and portal circulation will be reduced and arterial blood flow will improve. Splenic artery embolization is a procedure introduced many years ago for the management of splenic artery steal syndrome and small-for-size living donor liver transplantation. This procedure is performed in order to reduce portal hyperflow and consequently, ascites. In conclusion, splenic artery embolization is a therapeutic option for the treatment of refractory ascites after liver transplantation.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Embolización esplénica]]></kwd>
<kwd lng="es"><![CDATA[Ascitis refractaria]]></kwd>
<kwd lng="es"><![CDATA[Trasplante hepático]]></kwd>
<kwd lng="en"><![CDATA[Spleen embolization]]></kwd>
<kwd lng="en"><![CDATA[Refractory ascites]]></kwd>
<kwd lng="en"><![CDATA[Liver transplantation]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Quintini]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Splenic artery embolization for the treatment of refractory ascites after liver transplantation]]></article-title>
<collab>D'Amico G.Brown C</collab>
<source><![CDATA[Liver Trans]]></source>
<year>2011</year>
<volume>17</volume>
<page-range>668-73</page-range></nlm-citation>
</ref>
<ref id="B2">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Splenic artery syndrome as a possible cause of late onset refractory ascites after liver transplantation Management with proximal splenic artery embolization]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pravisani]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Baccarani]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Adani]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<source><![CDATA[Transplant Proc]]></source>
<year>2016</year>
<volume>48</volume>
<page-range>377-9</page-range></nlm-citation>
</ref>
<ref id="B3">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Persistent ascites after liver transplantation Etiology, treatment and impact on survival]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gotthardt]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Weiss]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Rathenberg]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<source><![CDATA[Ann Transplant]]></source>
<year>2013</year>
<volume>018</volume>
<page-range>378-83</page-range></nlm-citation>
</ref>
<ref id="B4">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Arroyo]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Gines]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Gerbes]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
</person-group>
<source><![CDATA[Hepatology]]></source>
<year>1996</year>
<volume>23</volume>
<page-range>164-76</page-range></nlm-citation>
</ref>
<ref id="B5">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients A 5 year experience]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Presser]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Quintini]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Tom]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[Liver Trans]]></source>
<year>2015</year>
<volume>21</volume>
<page-range>435-41</page-range></nlm-citation>
</ref>
<ref id="B6">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Regulation of hepatic blood flow The hepatic arterial buffer response revisited]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Eipel]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Abshagen]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Vollmar]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<source><![CDATA[World J Gastroenterol]]></source>
<year>2010</year>
<volume>16</volume>
<page-range>6046-57</page-range></nlm-citation>
</ref>
<ref id="B7">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Partial splenic embolization for hypersplenism in cirrhosis A long-term outcome in 62 patients]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zhou Zhu]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Meng]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Qian]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Dig Liver Dis]]></source>
<year>2009</year>
<volume>41</volume>
<page-range>411-6</page-range></nlm-citation>
</ref>
<ref id="B8">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Changes in platelet kinetics after a partial splenic arterial embolization in cirrhotic patients with hypersplenism]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Noghuci Noguchi]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Hirai]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Aoki]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<source><![CDATA[Hepatology]]></source>
<year>1995</year>
<volume>22</volume>
<page-range>1682-8</page-range></nlm-citation>
</ref>
<ref id="B9">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Partial splenic artery embolization for thrombocytopenia and uncontrolled massive ascites after liver transplantation]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kim]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Suh]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Jeon]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<source><![CDATA[Transplant Proc]]></source>
<year>2012</year>
<volume>44</volume>
<page-range>755-6</page-range></nlm-citation>
</ref>
<ref id="B10">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Splenic artery embolization for treatment of refractory ascites after liver transplantation]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Meighani]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Jafri]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Raoufi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<source><![CDATA[ACG Case Rep J]]></source>
<year>2016</year>
<volume>3</volume>
<page-range>136-8</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
