Selective Posttransplant Splenectomy in Recipients of Cadaveric Renal Allografts

Lewis, Richard M.; Banowsky, Lynn H.; Nicastro-Lutton, Judith J.; Cruz, Anatolio B.; Saunders, Paula H.

doi:10.1097/00007890-198308000-00018

Cited by 3 publications

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“…Two reports in the 1980s also noted improved patient and graft survival after splenectomy (7,8). This is in contrast to several reports in the late 1980s that have cautioned against the routine use of splenectomy in the renal transplant population (9,10,14,16,31,32).…”

Section: Discussioncontrasting

confidence: 72%

“…There are contradictory reports regarding the effect of splenectomy on allograft rejection following transplantation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Some have reported a beneficial effect of splenectomy either pre-or peritransplantation (1-4,6, 7, 9, 10) and have attributed this benefit to a reduction in antibody production (I, 2) or improved leukocyte count and therefore tolerance to azathioprine (AZA) (3, 4,6,10,15). Others have shown no benefit, discouraging the routine use of this procedure because of its potentially lethal complications due to delayed infection and thromboembolic events (5,8,13,16).…”

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confidence: 99%

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Samimi¹,

Irish²,

Eghtesad³

et al. 1998

Digestive Diseases and Sciences

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Between January 1987 and October 1991, 1466 patients underwent consecutive Orthotopic Liver Transplantation (OLTx) at the University of Pittsburgh. Forty of these patient's had concomitant splenectomy with OLTx. These patients were compared to 147 randomly selected OLTx patients without splenectomy within the same time period. One-year patient and graft survival (PS and GS) were lower in splenectomized (Splx) patients compared to nonsplenectomized (non-Splx) patients (59% vs 86% PS, 55% vs 80% GS, respectively). One-month and one-year patient mortality in the Splx group was higher than in the non-splx patients (20% vs 3.4%, P < 0.001 for one month; 40% vs 14.3%, P = 0.003 for one year, respectively). One-month and one-year sepsis-related mortality was also high in Splx patients (17.5% vs 2.7%, P = 0.0022, for one month, and 30% vs 11.5%, P = 0.0043, for one year, respectively). We conclude that concomitant splenectomy with OLTx has a significantly higher patient mortality mainly due to its septic complications and, at present, unless there is a specific indication for a splenectomy, the routine addition of this procedure to liver allograft surgery would not be recommended.

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