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

Matsukiyo, Yasushi; Nagai, Hidenari; Matsui, Teppei; Igarashi, Yoshinori

doi:10.1155/2018/1746391

Cited by 11 publications

(11 citation statements)

References 45 publications

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Section: Discussionmentioning

confidence: 93%

“…The immediate improvement in the WBC count due to PSE could be attributed to the release of white cells from the spleen, considering it as an acute inflammatory response. The long-term improvement in the WBC count in the EP group could be ascribed to an improvement in the blood-producing function of the bone marrow after PSE [ 26 , 27 ]. The PLT count might have increased due to improvement in the hepatic production of thrombopoietin (TPO) after PSE, as well as due to the reduction in the splenic platelet pool and increase in the platelet survival time [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…An increased amount of PCNA-positive hepatocytes was observed in the post-PSE liver. These cells are reported to exhibit high proliferative activity, indicating that PSE may induce a liver regenerative response [ 27 ]. In addition, PSE may induce the activation of host immunity via complicated interactions between T cells and cytokines, and thereby improving liver function and coagulation function.…”

Section: Discussionmentioning

confidence: 99%

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Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

et al. 2021

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Background Global research on endoscopic therapies in combination with partial splenic embolization (PSE) for variceal hemorrhage (VH) is limited. Therefore, we aimed to evaluate the efficacy and safety of endoscopy plus PSE (EP) treatment in comparison to endoscopic (E) treatment for the secondary prophylaxis of VH in cirrhosis patients with hypersplenism. Methods Cirrhosis patients with hypersplenism (platelet count < 100, 000/µL) and those who had recovered from an episode of VH were enrolled in a multicenter randomized controlled trial. The participants were randomly assigned into EP and E groups in a 1:1 ratio. The primary endpoint was variceal rebleeding, and the secondary endpoints were severe variceal recurrence and mortality during the 2-year follow-up. Hematological indices, serum biochemical parameters, and the Child–Pugh score were measured at each time point. Results From June 2016 to December 2019, 108 patients were enrolled in the study, among which 102 patients completed the protocol (51 in EP and 51 in E group). The rebleeding rate of the varices was significantly reduced in the EP group compared to that in the E group during the 2 years (16% vs. 31%, p < 0.001). The EP group showed a significantly lower variceal recurrence rate than the E group (22% vs. 67%, p < 0.001). The COX proportional hazard models revealed that grouping was an independent predictor for variceal rebleeding (H = 0.122, 95% CI 0.055–0.270, p < 0.001) and variceal recurrence (hazard ratio, H = 0.160, 95% CI 0.077–0.332, p < 0.001). The peripheral blood cell count, Child–Pugh class/score, albumin concentration, and coagulation function in the EP group improved significantly compared to the values observed in the E group at any time point (p < 0.05). Conclusions The EP treatment was more effective in preventing variceal rebleeding and variceal recurrence than the conventional E treatment during the secondary prophylaxis of VH in cirrhosis patients with hypersplenism. Furthermore, the EP treatment could significantly increase the peripheral blood cell count and albumin concentration and also improved the coagulation function and the Child–Pugh score. Clinical trials registration Trial registration number ClincialTrials.gov: NCT02778425. The URL of the clinical trial: https://clinicaltrials.gov/

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

et al. 2021

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“…PSE can reduce the absolute number of Th2 lymphocytes, restore the Th1/Th2 imbalance, to the advantage of Th1, thereby inhibiting liver fibrosis. [ 26 , 27 ] Also, thrombocytosis after PSE can also inhibit liver fibrosis. [ 28 ] Improved liver function can enhance liver protein synthesis and reduce the severity of hepatic encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

Effect of partial splenic embolization on transarterial chemoembolization for hepatocellular carcinoma with hypersplenism

Liu

Zhang

et al. 2021

Medicine

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This study retrospectively studied transarterial chemoembolization (TACE) combined with partial splenic embolization (PSE) in the treatment of hepatocellular carcinoma (HCC) with severe hypersplenism. Seventy patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stage B or C with hypersplenism were divided into non-partial splenic embolization group (N-PSE, n = 51) and partial splenic embolization group (PSE, n = 19). The N-PSE group was further divided into N-PSE with mild to moderate hypersplenism (N-PSE-M, 47 cases) and N-PSE with severe hypersplenism (N-PSE-S, 4 cases). In the PSE group, leukocytes, neutrophils, lymphocytes, and platelets were significantly increased ( P < .05) and were significantly different from that in the N-PSE group ( P < .05). In the N-PSE group, except for a slight increase in neutrophils, other blood cells were decreased, including lymphocytes that were significantly decreased ( P < .05). There was no significant difference in the changes of liver function between the 2 groups before and after surgery ( P > .05). The analysis showed a significant increase in ascites after 6 months of TACE in the N-PSE group ( P < .05). According to the follow-up results, the median overall survival (OS) in the PSE group was 24.47 ± 3.68 (months) and progression-free survival (PFS) was 12.63 ± 4.98 (months). Regardless of OS or PFS, the PSE group was superior to the N-PSE group and its subgroups, with a statistically significant difference in PFS between the N-PSE group and PSE group ( P < .05). Moreover, the time of extrahepatic progression was significantly earlier in the N-PSE group than in the PSE group ( P < .05). N-PSE-S group had the worst prognosis, and PFS and OS were worse than the other 2 groups, suggesting that PSE in severe hypersplenism may improve PFS and OS. In patients with HCC and severe hypersplenism, TACE should be actively combined with PSE treatment.

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“…Partial splenic embolization (PSE) via catheter intervention is also known to be an effective alternative to splenectomy that is less invasive than surgery. Interestingly, Matsukiyo et al recently reported that PSE not only improve leukopenia and thrombocytopenia but also induce activation of CD4 + T cells, including Th1 and Th2 cells, in patients with cirrhosis and thrombocytopenia (44). Because the current study did not address Th1 and Th2 cytokine expression and their balance in CD4 + T cells, it would be interesting to examine them before and after splenectomy and compare them with those after PSE in cirrhotic patients in future studies.…”

Section: Discussionmentioning

confidence: 87%

Immunological consequences following splenectomy in patients with liver cirrhosis

et al. 2019

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The immune status in patients with liver cirrhosis is generally impaired due to concomitant hypersplenism. As the spleen is the largest lymphoid organ, deleterious events resulting from splenectomy are of concern in these patients. However, the immunological consequences after splenectomy have not yet been fully elucidated. In the present study, the immune status after splenectomy was comprehensively examined. Splenectomy was performed in 11 patients with liver cirrhosis and hypersplenism, and the immune status in peripheral blood was examined and compared before and at 1, 3 and 6 months after splenectomy. Splenectomy significantly lowered the neutrophil-to-lymphocyte ratio, due to a surge in lymphocytes in the peripheral circulation at 3 and 6 months after splenectomy. The frequency of cluster of differentiation (CD)4 + T cells decreased after splenectomy, whereas the frequency of CD8 + T cells increased. Notably, the frequencies of the naïve and central memory subsets of CD4 + and CD8 + T cells decreased, whereas those of the effector memory subset trended upward. In addition, the frequencies of other immune cells such as γδ T cells, natural killer T cells and natural killer cells transiently increased, while inhibitory cells such as regulatory T cells and myeloid-derived suppressor cells significantly decreased. T-cell responses to viral-and tumor-associated antigens increased after splenectomy in five of eight and two of five patients, respectively. To the best of our knowledge, this is the first study to precisely examine the drastic changes of immunological phenotypes in peripheral blood after splenectomy in patients with cirrhosis. Our findings suggested that splenectomy in patients with cirrhosis may ameliorate the impaired immune status, possibly by reducing suppressive cells and enhancing the effector cell population and function, which could, at least in part, explain the mechanisms responsible for the clinical benefits of splenectomy.

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

Cited by 11 publications

References 45 publications

Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

Effect of partial splenic embolization on transarterial chemoembolization for hepatocellular carcinoma with hypersplenism

Immunological consequences following splenectomy in patients with liver cirrhosis

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