Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury.
BACKGROUND
Splenic artery angioembolization (SAE) is increasingly being used as an adjunct to nonoperative management for stable patients with blunt splenic injury (BSI). However, little is known about splenic immunocompetence after SAE. This study aims at assessing splenic immunocompetence after SAE for BSI.


METHODS
Peripheral blood was obtained from BSI patients (n = 8) who had SAE >6 months prior. Splenic immunocompetence was assessed by isolating mononuclear cells and incubating with CD4 and CD45RA and CD45RO antibody to analyze the proportion of T-cells expressing CD4 receptor, or coexpressing CD4 and either CD45RA or CD45RO receptors. Cells were counted by fluorescence-activated cell sorting and compared with trauma patients that had splenectomy for BSI also >6 months prior (n = 4, negative controls) and normal healthy volunteers with intact spleens (n = 4, positive controls).


RESULTS
The test was discriminatory for the asplenic state. %CD4 cells were significantly lower in splenectomized patients (16 ± 1) versus normal (40 ± 2), p < 0.05. This was due to significant decrease (8 ± 2 vs. 26 ± 4, p < 0.05) in %CD4CD45RA cells whereas the proportion of CD4CD45RO cells were maintained similar to normal. SAE patients had values (CD4, 36 ± 2, and CD4CD45RA, 24 ± 2) comparable to normal (p > 0.05) and significantly higher than splenectomized patients (p < 0.05). When the SAE group was subdivided into main (total, n = 4) and branch vessel (partial, n = 4) SAE, results were the same for both types of SAE.


CONCLUSIONS
Splenic immune function, measured by T-cell subset, generated only in the presence of an immunocompetent spleen, is preserved after SAE for BSI, main or partial.
Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA. akmalhot@mcvh-vcu.edu
Ajai K
AK
Malhotra
Richard F
RF
Carter
Deborah A
DA
Lebman
Dawn S
DS
Carter
Omer J
OJ
Riaz
Michel B
MB
Aboutanos
Therese M
TM
Duane
Rao R
RR
Ivatury
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007121:Immunocompetence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011309:Preservation, Biological / Q000379:methods*; D013154:Spleen / Q000098:blood supply / Q000276:immunology* / Q000293:injuries; D013156:Splenectomy; D013157:Splenic Artery / Q000000981:diagnostic imaging*; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000276:immunology / Q000628:therapy*; D055815:Young Adult