title: Effect of esophagogastric devascularization with splenectomy on schistossomal portal hypertension patients' immunity.
abstract: BACKGROUND
  Surgical treatment of hemorrhagic complication in schistosomal portal hypertension in our hospital is an esophagogastric devascularization procedure with splenectomy. Infectious risks and immunological alterations imputed to splenectomy may have significant importance. To minimize the consequences of spleen absence, the use of subtotal splenectomy and spleen auto-transplantation were stimulated.
  
  
  OBJECTIVE
  To verify the immunologic alterations imposed by this procedure in our patients.
  
  
  METHODS
  Twenty-eight patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophagogastric varices rupture underwent elective esophagogastric devascularization and splenectomy. They were prospectively studied before esophagogastric devascularization procedure with splenectomy, 15 and 30 days, 3 and 6 months after the procedure. T and B-lymphocytes, CD4 and CD8 subpopulations were determinated by monoclonal antibodies. Immunoglobulins A, M, G and C3, C4 components of the complement were determinated by radial immunodiffusion.
  
  
  RESULTS
  We observed important reduction of all immune cells, increase of IgG and normal levels of IgM, IgA, C3 and C4 at preoperative. CD4/CD8 relation was normal. Six months after esophagogastric devascularization procedure with splenectomy, significant increase in T-lymphocytes, CD4, CD8 and B-lymphocytes were observed. CD4/CD8 relation remained normal. We noted significant increase in C3. IgA, IgM, IgG and C4 had increased, but without significant difference.
  
  
  CONCLUSIONS
  Esophagogastric devascularization procedure with splenectomy determines an increase in T and B-lymphocytes, CD4 and CD8 subpopulations without compromising immunoglobulins and components of complement levels.
authors.affiliation: Liver and Portal Hypertension Unit, Surgery Department, Santa Casa Medical School and Hospital, São Paulo, SP. drfabioferreira@gmail.com
authors.forename: Fabio Gonçalves
authors.initials: FG
authors.lastname: Ferreira
authors.forename: Wilma Carvalho Neves
authors.initials: WC
authors.lastname: Forte
authors.forename: José Cesar
authors.initials: JC
authors.lastname: Assef
authors.forename: Armando
authors.initials: A
authors.lastname: De Capua
mesh_terms: D000293:Adolescent; D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D016516:CD4-CD8 Ratio; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000276:immunology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000276:immunology / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000276:immunology / Q000601:surgery*; D007136:Immunoglobulins / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012555:Schistosomiasis mansoni / Q000150:complications / Q000276:immunology / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D007136:Immunoglobulins