We read with great interest the recent article 1 describing Moon et al.'s experience with splenic artery aneurysms (SAAs) in adult living donor liver transplant recipients. The authors retrospectively reviewed 44 liver transplant recipients with SAAs out of 310 patients. Interestingly, portosystemic shunts were present in all patients, with the diameter of these collaterals being the only significant factor for the presence of SAAs. Three patients presented with a ruptured aneurysm in the postoperative period, and 2 of these had undergone splenic artery ligation at the time of transplantation. After this experience, the authors changed their policy, and they now recommend aggressive treatment of SAAs, either surgical or radiological, within 24 hours of transplantation, before or afterward. Nevertheless, other facts are also worth noting in this report. First, despite the recommendation of proximal and distal ligation of the splenic artery for a unique extrasplenic aneurysm, only proximal ligation was possible in 6 patients, and 2 of them suffered an SAA rupture. Second, 32 patients with SAAs ranging from 10.5 to 25 mm were not treated during the study period; they had no complications, and they experienced a significant reduction of the mean aneurysm diameter after 1-year of follow-up.
Our experience is similar to the latter finding. From February 1996 to May 2009, 786 liver transplants were performed in our institution with whole grafts from deceased donors. In a retrospective analysis, we found 7 recipients with SAAs diagnosed during the transplant assessment. All patients had a unique SAA in the distal third of the splenic artery with a diameter ranging from 10 to 30 mm. No prophylactic treatment was indicated, and no complications occurred. After a median follow-up of 106 months (range ¼ 5-132 months), the size of the SAAs decreased from 30 to 20 mm in 2 patients, whereas the others remained unchanged. The incidence of SAAs in our series was probably underestimated because of the retrospective