title: Transplantation of the spleen: effect of splenic allograft in human multivisceral transplantation.
abstract: OBJECTIVE
  To describe the effect of the splenic allograft in human multivisceral transplantation.
  
  
  BACKGROUND
  We performed transplants of the spleen as part of a multivisceral graft in an attempt to decrease both the risk of infection from an asplenic state and the risk of rejection by a possible tolerogenic effect. To our knowledge, this is the first report of human splenic transplantation in a large series.
  
  
  METHODS
  All primary multivisceral recipients who received a donor spleen (N = 60) were compared with those who did not receive a spleen (N = 81).
  
  
  RESULTS
  Thirty-five of 60 (58%) are alive in the spleen group, and 39 of 81 (48%) are alive in control group (P = 0.98). In univariate analysis, splenic recipients showed superiority in freedom-from-any rejection (P = 0.02) and freedom-from-moderate or severe rejection (P = 0.007). No significant differences were observed in analyses of infectious complications between the spleen and control groups. Both platelet and leukocyte counts became normal in splenic patients, whereas these counts were significantly increased in nonsplenic recipients. Observed incidence of graft versus host disease (GVHD) was 8.25% (5 of 60) in the spleen group and 6.2% (5 of 81) in the control group (P = 0.70). Increased incidence of autoimmune hemolysis was observed in the spleen group.
  
  
  CONCLUSIONS
  Allograft spleen can be transplanted within a multivisceral graft without significantly increasing the risk of GVHD. The allogenic spleen seems to show a protective effect on small bowel rejection. Further investigation with longitudinal follow-up is required to precisely determine the immunologic and hematologic effects of the allograft spleen.
authors: Departments of Surgery, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA. tkato@med.miami.edu
authors: Tomoaki
authors: T
authors: Kato
authors: Andreas G
authors: AG
authors: Tzakis
authors: Gennaro
authors: G
authors: Selvaggi
authors: Jeffrey J
authors: JJ
authors: Gaynor
authors: Hidenori
authors: H
authors: Takahashi
authors: James
authors: J
authors: Mathew
authors: Rolando
authors: R
authors: Garcia-Morales
authors: Erick
authors: E
authors: Hernandez
authors: Andre
authors: A
authors: David
authors: Seigo
authors: S
authors: Nishida
authors: David
authors: D
authors: Levi
authors: Jang
authors: J
authors: Moon
authors: Eddie
authors: E
authors: Island
authors: Gary
authors: G
authors: Kleiner
authors: Phillip
authors: P
authors: Ruiz
mesh_terms: D000293:Adolescent; D000328:Adult; D001772:Blood Cell Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D013154:Spleen / Q000637:transplantation*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014781:Viscera / Q000637:transplantation*
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