Prophylaxis against late infection following splenectomy and bone marrow transplant

Fielding, Adele K.

doi:10.1016/0268-960x(94)90079-w

Cited by 25 publications

(10 citation statements)

References 47 publications

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“…In this study the high mortality rates were caused mainly by infectious septic complications. Similar results in the past have been reported after bonemarrow transplantation [12].…”

Section: Discussionsupporting

confidence: 91%

Simultaneous splenectomy increases risk for opportunistic pneumonia in patients after live transplantation

Neumann¹,

Langrehr²,

Kaisers³

et al. 2002

Transplant Int

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Life threatening pneumonias after liver transplantation are often caused by opportunistic pathogens such as Legionella pneumophila, Pneumocystis carinii, Aspergillus species and cytomegalovirus (CMV). Due to the high incidence of morbidity and mortality caused by these pneumonias we reviewed 700 liver transplants for risk factors for the development of opportunistic pneumonia. Immunosuppression was commenced as either cyclosporin A-or tacrolimusbased protocols. In a subgroup of patients, splenectomy was performed simultaneously with liver transplantation ( n = 57). Overall 60 opportunistic pneumonias occurred in 700 liver transplants. Using a stepwise logistic regression analysis, we found that OKT3 treatment and simultaneous splenectomy revealed a significantly increased risk for opportunistic pneumonia. Our study identified splenectomy as a major risk factor for the development of opportunistic pneumonia after liver transplantation. In these patients prophylactic protocols and early diagnosis may improve the long-term outcome.

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“…In this study the high mortality rates were caused mainly by infectious septic complications. Similar results in the past have been reported after bonemarrow transplantation [12].…”

Section: Discussionsupporting

confidence: 91%

Simultaneous splenectomy increases risk for opportunistic pneumonia in patients after live transplantation

Neumann¹,

Langrehr²,

Kaisers³

et al. 2002

Transplant Int

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“…Previous reports have consistently stated that the highest OPSI risk lies within the first few years after surgery. 8 Our analysis demonstrates that the increased risk of severe sepsis is lifelong. Almost the same number of cases occurred more than 40 years after surgery as were seen within the first four years of surgery, with most cases (60%) occurring 10-30 years after splenectomy.…”

Section: Discussionmentioning

confidence: 81%

Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed

Waghorn

2001

Journal of Clinical Pathology

339

222

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Aims-Patients without spleens are at increased risk of overwhelming infection. Recently, greater eVorts, including the publication of national guidelines, have been made to improve the management of asplenic individuals. In theory, risks of serious sepsis can be reduced by good advice, immunisation, and antibiotic prophylaxis. In practice, such preventive measures might not be followed or may fail. A study of recent cases of overwhelming postsplenectomy infection (OPSI) was undertaken to examine specific associated factors and to determine whether currently recommended preventive measures are being followed. Methods-Cases of OPSI were identified and reported mainly by microbiologists across the country using a specifically designed proforma. Data including the nature of the infection and vaccination/ antibiotic prophylaxis history since splenectomy were obtained. Results-Seventy seven cases were reported. The age range varied from 3 months (congenital asplenia) to 87 years. In those who had undergone surgical splenectomy, the time interval between surgery and OPSI varied from 24 days to 65 years. Overall mortality reached 50%, with underlying haematological malignancy associated with the highest death rate. Streptococcus pneumoniae caused approximately 90% episodes. Only 31% individuals had received pneumococcal vaccination before OPSI. Seven of 17 pneumococcal infections in immunised cases could be considered vaccine failures. Few patients had been adequately advised on antibiotic prophylaxis or other measures. Conclusions-Currently accepted best practice for managing asplenic patients is not being followed. Some OPSI cases may still be preventable but many asplenic individuals remain unrecognised. The compilation of asplenic patient registers might help to implement agreed policies with audit necessary to evaluate compliance. More is needed to ensure optimal management for this cohort of the population. (J Clin Pathol 2001;54:214-218)

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“…Previous reports have consistently stated that the highest OPSI risk lies within the first few years after surgery. 8 A recent analysis, however, demonstrated that the increased risk of severe sepsis is lifelong. The author observed the occurrence of the same number of cases more than 40 years after surgery as seen within the first 4 years of surgery with most cases (60%) occurring 10-30 years after splenectomy.…”

Section: Discussionmentioning

confidence: 97%

Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention?

Elalfy¹,

El-Sayed²

2004

Hematol J

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Prophylaxis against late infection following splenectomy and bone marrow transplant

Cited by 25 publications

References 47 publications

Simultaneous splenectomy increases risk for opportunistic pneumonia in patients after live transplantation

Simultaneous splenectomy increases risk for opportunistic pneumonia in patients after live transplantation

Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed

Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention?

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