Splenic autotransplantation: a systematic review

Abstract

Background: Splenectomy is a surgical procedure indicated in a variety of medical conditions including trauma. Postoperatively, there is a lifelong risk of developing overwhelming sepsis from encapsulated bacteria, most commonly due to Streptococcus pneumoniae. Splenic autotransplantation has been proposed as a method to recover splenic function in patients requiring splenectomy with otherwise normal spleens. This paper aims to systematically review the literature to determine the efficacy of spleen autotransplantation.Methods: MEDLINE, PubMed and the Cochrane Library were searched for all studies assessing splenic autotransplantation (January 1947 to July 2018). Data was extracted on study characteristics, outcomes assessed, including spleen scintigraphy results, blood film counts and serum immunoglobulin levels.Results: Data was obtained from 18 primary studies. All papers demonstrated return of regenerated spleen tissue in the majority of their patients (95.3%) on spleen scintigraphy. 90.2% of patients in 12 studies had blood films return to normal following transplantation. Immunoglobulin levels were shown to return to normal in all 12 studies where it was assessed. 3.7% of patients in 11 studies had postoperative complications.1.3% of patients in five studies had postoperative infections in the follow-up period.

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

“…This is confirmed by many reports, according to which autotransplantation of the spleen is accompanied by less pronounced immunohematological changes, compared with splenectomy, but is inferior to organ-sparing operations [11]. At the same time, according to the literature, removal of 90 % of the spleen does not lead to the development of hyposplenism [12]. The presented data significantly changed the tactics in the management of the diseases of the spleen.…”

Splenic auto‐transplantation after splenectomy for trauma: evaluation of a new technique

“…3,4,9 Most studies implanted slices of the spleen or minced splenic tissue into the omentum, which made them more prone to ischaemia from torsion of the omentum, trauma, and bleeding or intestinal obstruction. 9 Di Carlo et al 5 have proposed a new technique for implanting a single segment of the spleen (approximately 25-30 cm 3 in size) in the native site of the original spleen and fixed to it. In this way, the implanted splenic tissue would be protected by the rib cage, and the risk of traumatic bleeding, intestinal obstruction or torsion of the omentum significantly decreases.…”

“…However, whether the implanted splenic tissues could offer patients protection against infection by encapsulated bacteria or prevent OPSI is yet to be confirmed. 9,12 Some studies have reported the occurrence of fatal OPSI in patients with splenosis or implanted splenic tissues despite receiving pneumococcal vaccination. Nevertheless, they were case reports published four decades ago.…”

“…Most studies have shown haematological and radiological evidence of the recovery of hemocathartic function of the spleen. However, whether the implanted splenic tissues could offer patients protection against infection by encapsulated bacteria or prevent OPSI is yet to be confirmed 9,12 …”

“…With respect to the optimal volume of splenic tissues that should be implanted, Surendran et al 9 . have suggested that it should be equal to or more than 20 cm 3 to provide adequate splenic functions.…”