Immunological consequences following splenectomy in patients with liver cirrhosis

Abstract

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.

Distribución de glóbulos periféricos después de la esplenectomía en pacientes

“…In a recent study, it was concluded that splenectomy might improve the weakened immune system of patients with cirrhosis, possibly by reducing suppressive cell fractions and amplifying the effector cell population. In that study, splenectomy was found to decrease NLR 16 . We supposed that, based on the decrease in the NLR and PLR, splenectomy did not only eliminate sequestration but also ameliorated the inflammation in ITP patients.…”

The Benefits of Radical Treatments with Synchronous Splenectomy for Patients with Hepatocellular Carcinoma and Portal Hypertension

“…Splenectomy can alleviate PH, elevate platelet count level, and ameliorate hyperbilirubinemia, which, in turn, promote hepatocyte regeneration [16]. In addition, a significant decrease in suppressive regulatory T cells and myeloid-derived suppressor cells after splenectomy is observed [17], and an increase in the number and function of lymphocytes, especially effector T cells, reverses the body's immune suppression of the tumor and induces tumor regression, which may have a preventive effect on HCC recurrence after hepatectomy or radiofrequency ablation [18,19]. Despite the existence of the anti-tumor immune advantage, the duration of maintenance of this beneficial change in immune function in patients with cirrhosis is also a topic that deserves in-depth investigation.…”

Splenectomy in Liver Cirrhosis with Splenomegaly and Hypersplenism

“…However, a study by Hirakawa et al, showed the possibility of reducing suppressive cell fractions and enhancement of the effector cell population and functions by means of splenectomy, thus ameliorate the impaired immune status of cirrhotic patients [7].…”