Antibody Response to a T-Cell-Independent Antigen Is Preserved after Splenic Artery Embolization for Trauma

Abstract

Splenic artery embolization (SAE) is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. The aim of this study was to assess the splenic function of patients who were embolized. A clinical study was performed, with splenic function assessed by examining the antibody response to polysaccharide antigens (pneumococcal 23-valent polysaccharide vaccine), B-cell subsets, and the presence of Howell-Jolly bodies (HJB). The data were compared to those obtained from splenectomized patients and healthy controls (HC) who had been included in a previously conducted study. A total of 30 patients were studied: 5 who had proximal SAE, 7 who had distal SAE, 8 who had a splenectomy, and 10 HC. The median vaccine-specific antibody response of the SAE patients (fold increase, 3.97) did not differ significantly from that of the HC (5.29; P ‫؍‬ 0.90); however, the median response of the splenectomized patients (2.30) did differ (P ‫؍‬ 0.003). In 2 of the proximally embolized patients and none of the distally embolized patients, the ratio of the IgG antibody level postvaccination compared to that prevaccination was <2. There were no significant differences in the absolute numbers of lymphocytes or B-cell subsets between the SAE patients and the HC. HJB were not observed in the SAE patients. The splenic immune function of embolized patients was preserved, and therefore routine vaccination appears not to be indicated. Although the median antibody responses did not differ between the patients who underwent proximal SAE and those who underwent distal SAE, 2 of the 5 proximally embolized patients had insufficient responses to vaccination, whereas none of the distally embolized patients exhibited an insufficient response. Further research should be done to confirm this finding.T he spleen is one of the most commonly injured organs after blunt trauma (1, 2). It is involved in the antibody response against infection, most importantly against encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis group C (3, 4). Other functions of the spleen include storing B and T lymphocytes, plasma cells, and iron and filtering the blood, including removing damaged or old erythrocytes.Surgery (splenectomy) has long been the preferred treatment strategy for patients with traumatic injury to the spleen. After a splenectomy, patients have an increased risk of developing an overwhelming postsplenectomy infection (OPSI), which occurs after only 0.5% of all splenectomies in trauma patients but carries a mortality rate of around 50% to 70% (5). The risk of OPSI was one of the driving factors behind the evolution toward the use of more nonoperative treatment (NOM) strategies for splenic injury.Splenic artery embolization (SAE) is a nonoperative treatment strategy that can be used as an adjunct to observation in cases with an arterial bleeding focus. Advantages of NOM over surgical treatment include the avoidance of surgery-associated complic...

Review of proximal splenic artery embolization in blunt abdominal trauma

“…Splenic function is preserved after splenic embolization (Bessoud et al 2007;Olthof et al 2014). Preserved phagocytosis is confirmed by the absence of Howell-Jolly bodies (abdormal bsophilic nuclear remnants withing red blood cells due to deficient phagocytosis) after splenic embolization (Olthof et al 2014;Pirasteh et al 2012). Splenic dependent T-cell immunity is preserved after splenic embolization.…”

“…The levels of two subpopulations of CD4+ T cells (CD4 + CD45RA+ and CD4 + CD45RO+), which are essential in antigen induced T-cell proliferation, are markedly diminished in asplenic patients but are normal after splenic embolization (Malhotra et al 2010). Finally, antibody response to pneumococcal polysaccharide vaccine is preserved after splenic embolization but is blunted in asplenic patients (Olthof et al 2014). Routine Fig.…”

Divergent humoral responses to 23-valent pneumococcal polysaccharide vaccine in critically-ill burn and neurosurgical patients

“…Of note, our sample size limits our ability to draw firm conclusions about safety of PPSV23 in these populations even though no significant events were noted. However, it is comparable in size to other vaccine responsiveness studies in other populations such as recovered trauma patients who required splenic artery embolization or solid organ transplant recipients [ 50 , 51 ].…”

Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

“…The life-threatening infection in after SAE was relative rare with the covering use of prophylactic antibiotics. Routine vaccination was not indicted because the patients had normal splenic function after splenic artery embolization for trauma [ 24 ]. The embolic therapy discussed herein is minimally invasive, is of low risk, and is well tolerated by patients.…”