Single segment of spleen autotransplantation, after splenectomy for trauma, can restore splenic functions

Abstract

Background: Splenectomy is sometimes necessary after abdominal trauma, but splenectomized patients are at risk of sepsis due to impaired immunological functions. To overcome this risk, autotransplantation of the spleen by using a new technique has been proposed, but so far, a demonstration of functionality of the transplanted tissue is lacking.Methods: We therefore evaluated 5 patients who underwent a splenic autotransplant in comparison with 5 splenectomized patients without splenic autotransplant and 7 normal subjects.Results: We confirmed that the patients not undergoing autotransplantation, when compared to normal subjects, had a higher platelet count, higher percentage of micronucleated reticulocytes (p = 0.002), increased levels of naive B lymphocytes (p = 0.01), a defect of class-switched memory (p = 0.001) and class-unswitched memory B cells (p = 0.002), and increased levels of PD1 on T lymphocytes CD8+ (p = 0.08). In contrast, no significant differences for any of the abovementioned parameters were recorded between patients who underwent spleen autotransplantation and normal subjects.Conclusion: These findings suggest that splenic autotransplantation is able to restore an adequate hemocatheretic activity as well as recover the immunological deficit after splenectomy.

Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

“…Physicians should also be careful not to interpret as an OPSI, the occurrence of severe chest or abdominal infections or other infections or seasonal flu that are NOT or unlikely to be related to splenectomy and would have occurred regardless the patient had their spleen removed. Finally, laparoscopic splenectomy can easily be combined with autotransplantation of a fragment or single segment of the native spleen, even if this was shattered, and may, therefore, represent a minimally invasive possibility for preserving splenic function after traumatic splenectomy [46,47]. Laparoscopic Autotransplantation of a fragment of the native spleen after morcellation and extraction of the traumatized spleen, is theoretically worth practicing and likely the subject of a future prospective study.…”

“…Finally, laparoscopic splenectomy can easily be combined with autotransplantation of a fragment or single segment of the native spleen, even if this was shattered, and may, therefore, represent a minimally invasive possibility for preserving splenic function after traumatic splenectomy [ 46 , 47 ]. Laparoscopic Autotransplantation of a fragment of the native spleen after morcellation and extraction of the traumatized spleen, is theoretically worth practicing and likely the subject of a future prospective study.…”

Changes in the filtration function of the spleen after surgery following traumatic organ injuries

“…According to the classification of splenic injuries proposed by the American Association of Surgical Trauma [13], 8 (9.41 %) patients were classified as splenic injuries, 18 (21.18 %) patients with II degree injuries, and 28 (32.94 %) patients with III degree, 23 (27.07 %) patients with IV degree and 6 (7.04 %) patients with V degree. 5 (5.88 %) patients were diagnosed with post-traumatic cyst of the spleen.…”

Sclerosing angiomatoid nodular transformation of the spleen: A case report and literature review

“…The patient and her relatives were informed about the increased risk of overwhelming post-splenectomy infection (OPSI) after splenectomy. They were also informed about the need for an intraoperative histopathological examination of the spleen, and if the tumor was benign, a spleen autotransplantation would be considered[ 2 ]. However, due to the possibility of missing a malignancy on intraoperative histopathological examination and the low risk of OPSI in adults, the patient and her family members insisted on splenectomy and declined an intraoperative histopathological examination.…”