Transplantation of the spleen: effect of splenic allograft in human multivisceral transplantation.
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.
Kato
Tomoaki
T
Departments of Surgery, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA. tkato@med.miami.edu
Tzakis
Andreas G
AG
Selvaggi
Gennaro
G
Gaynor
Jeffrey J
JJ
Takahashi
Hidenori
H
Mathew
James
J
Garcia-Morales
Rolando
R
Hernandez
Erick
E
David
Andre
A
Nishida
Seigo
S
Levi
David
D
Moon
Jang
J
Island
Eddie
E
Kleiner
Gary
G
Ruiz
Phillip
P
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*
Clin Exp Immunol. 1973 May;14(1):1-18
4736746
Nat Immunol. 2005 Apr;6(4):345-52
15785760
Nature. 1974 Feb 15;247(5441):465-6
4594434
Birth Defects Orig Artic Ser. 1973 Mar;9(2):102-5
4154784
Lancet. 1978 Jan 28;1(8057):178-81
74605
Transplantation. 1978 Jul;26(1):28-34
354119
World J Surg. 1980 Jul;4(4):423-32
7015698
Surg Gynecol Obstet. 1984 Sep;159(3):265-72
6382661
Transplantation. 1985 Sep;40(3):299-304
3898494
Transplantation. 1986 Apr;41(4):544-6
3515658
Ann Surg. 2005 Oct;242(4):480-90; discussion 491-3
16192808
Ann Surg. 2006 May;243(5):710-1
16633012
Ann Surg. 2006 Jun;243(6):756-64; discussion 764-6
16772779
Pediatr Transplant. 2007 Aug;11(5):547-51
17631026
Pediatr Dev Pathol. 2001 Mar-Apr;4(2):105-21
11178626
World J Surg. 2002 Feb;26(2):226-37
11865353
Transplant Proc. 2002 Aug;34(5):1929-31
12176633
Lancet. 2003 May 3;361(9368):1502-10
12737859
Transpl Int. 2003 Jul;16(7):451-60
12851762
Pediatr Clin North Am. 2003 Dec;50(6):1419-33, ix
14710785
Clin Transplant. 2004 Jun;18(3):332-5
15142057
Transplantation. 1969 Jan;7(1):73-5
5762196
Lancet. 1971 Jun 19;1(7712):1260-4
4104716
Transplantation. 1986 May;41(5):626-33
2939608
Transplantation. 1987 Oct;44(4):553-8
2960039
Chin Med J (Engl). 1992 Jul;105(7):609-11
1451569
Transplantation. 1993 Nov;56(5):1098-102
8249108
Arch Surg. 1995 Jan;130(1):33-9
7802574
J Clin Invest. 1997 Mar 1;99(5):1118-29
9062371
Transplantation. 1997 Aug 27;64(4):650-4
9293881
Immunol Today. 1998 Sep;19(9):421-6
9745206
J Clin Invest. 2004 Nov;114(9):1209-17
15520849
Ann N Y Acad Sci. 1964 Nov 30;120:626-51
14235278
Transplantation. 1974 Jan 1;17(1):75-83
4588157