Assessment of immune cells and function of the residual spleen after subtotal splenectomy due to splenomegaly in cirrhotic patients

Abstract

BackgroundThe spleen is thought to be central in regulating the immune system, a metabolic asset involved in endocrine function. Overwhelming postsplenectomy infection leads to a mortality rate of up to 50%. However, there is still controversy on performing subtotal splenectomy as treatment of splenomegaly due to portal hypertension in cirrhotic patients. In the present study, immunocytes and the indexes of splenic size, hemodynamics, hematology and immunology in the residual spleen were analyzed to support subtotal splenectomy due to splenomegaly.ResultsIn residual spleen, T lymphocytes mainly were focal aggregation in the periarterial lymphatic sheath. While B lymphocytes densely distributed in splenic corpuscle. In red pulp, macrophages were equally distributed in the xsplenic cord and adhered to the wall of splenic sinus with high density. The number of unit area T and B lymphocytes of splenic corpuscle and marginal zone as well as macrophages of red pulp were obviously increased in the residual spleen, while the number of macrophages didn’t be changed among the three groups in white pulp. While there were some beneficial changes (i.e., Counts of platelet and leucocyte as well as serum proportion of CD3+ T cells, CD4+ T cells, CD8+ T cells were increased markedly; serum levels of M-CSF and GM-CSF were decreased significantly; The proportion of granulocyte, erythrocyte, megakaryocyte in bone marrow were changed obviously; But serum IgA, IgM, IgG, Tuftsin level, there was no significant difference; splenic artery flow volume, portal venous diameter and portal venous flow volume, a significant difference was observed in residual spleen) in the clinical indices.ConclusionAfter subtotal splenectomy with splenomegaly due to portal hypertension in cirrhotic patients, the number of unit area T and B lymphocytes, and MØ in red pulp of residual spleen increased significantly. However, whether increase of T, B lymphocytes and MØs in residual splenic tissue can enhance the immune function of the spleen, still need further research to confirm.

Case report on the role of radiofrequency-assisted spleen-preserving surgery for splenic metastasis in the era of check-point inhibitors

“…[ 16 , 17 ] Immunologically, splenectomy is associated with loss of memory B cells which are preserved in the case of a partial splenectomy, where the number of T and B lymphocytes increase as do the number of monocytes in the red pulp. [ 18 – 20 ]…”

Host Immunological Effects of Partial Splenic Embolization in Patients with Liver Cirrhosis

“…It is possible that the WBC count increased due to release of white cells from the spleen. Bone marrow hyperplasia was reported in hypertensive patients with cirrhosis and hypersplenism [ 19 ], while serum levels of M-CSF and GM-CSF were significantly reduced by subtotal splenectomy in cirrhosis patients with splenomegaly secondary to portal hypertension [ 20 ]. In our patients with cirrhosis and thrombocytopenia who underwent PSE, the WBC count might not only have been increased by release of white cells from spleen but also by normalization of serum M-CSF and GM-CSF levels with suppression of marrow hyperplasia.…”

Activation of macrophage mediated host defense against Salmonella typhimurium by Morus alba L.

“…Thus, inflammatory signals produced by cells in the infected tissue rapidly recruit neutrophils and inflammatory monocytes to engulf replicating bacteria. Splenomegaly can cause splenic structure change; splenic tissue structure is correlated with the recruitment and expansion of T and B cells and macrophages ( 29 ). The present study provides evidence of the induction of the macrophage phagocytic effect by M. alba L.…”