AbstractWe report our experience with transcatheter partial splenic embolization (PSE) in 136 patients; 124 patients were treated in association with renal allograft protocols, 8 patients for hematologic disorders, and 4 patients for portal hypertension and esophageal varices. A total of 15 patients have died over the 1–8 year follow‐up period. Three deaths were a direct result of the procedure. Long‐term follow‐up for up to 8 years of the patients who underwent transplantation has revealed good renal allograft survival and no apparent increased mortality from late septic episodes. Seventeen major complications have occurred including pancreatitis (2), pseudocyst formation (2), splenic hematoma (1), pleural effusion (10), and splenic abscess (2). Fever, atelectasis, leukocytosis, pain, and hyperamylasemia were commonly seen and resolved rapidly. Children withβ‐thalassemia major, spherocytosis, andα1‐antitrypsin deficiency were benefited by PSE with no serious morbidity and no mortality. Two patients with splenic vein thrombosis and one with alcoholic cirrhosis were successfully managed by sequential PSE, as was 1 patient with massive splenomegaly from myelofibrosis. We conclude that PSE is a relatively safe and effective procedure in the management of certain patients with hypersplenism and portal hypertension, and that the long‐term risks of postsplenectomy sepsis may not be incurred.