Introduction:
Hypoperfusion of the hepatic artery includes two subtypes, which are
SASS and gastroduodenal steal syndrome. It is a nonocclusive disease of
the hepatic artery that often presents within 60 days of liver
transplantation (1). In addition to hypoperfusion of the hepatic artery,
SASS presents with blood flow being diverted to splenic parenchyma
through the splenic artery, and this syndrome may be an under-recognized
contributor to graft ischemia (2). Although most cases of SASS are
discovered within 60 days of liver transplantation, SASS can present up
to 5.5 years post-transplantation (3). The incidence of SASS ranges from
0.6% to 10.1% in liver transplant recipients (4). This wide range in
incidence is due to no fixed objective diagnostic criteria (4). It is
mainly a diagnosis of exclusion, and two important alternate diagnoses
often considered are hepatic artery stenosis and hepatic artery
thrombosis. Some studies have placed importance on pre-transplant
evaluation for risk factors and potential subsequent intervention to
reduce the risk of SASS (5,6). However, studies that have sought out
potential risk factors such as spleen-liver ratio, splenomegaly, and
pre-transplant splenic and hepatic artery size have had mixed results
(7,8,9).