title: Influence of splenectomy in patients with liver cirrhosis and hypersplenism.
abstract: OBJECTIVE
  Splenectomy improves hypersplenic thrombocytopenia in cirrhotic patients with hypersplenism. However, the long-term influence of splenectomy has not been clarified. We examined whether splenectomy improved liver fibrosis and caused immunological changes.
  
  
  METHODS
  We collected liver and spleen specimens and peripheral blood (PB) from 26 patients with hepatitis C virus-related liver cirrhosis. An immunohistochemical examination of CD4, CD8, forkhead box P3, granzyme B and transforming growth factor-β1, and Masson-trichrome stain were performed in spleen and liver tissues and in seven cases of follow-up liver biopsy sections obtained after splenectomy. We obtained PB before and at various intervals after splenectomy. We also examined the ratio of CD4(+) and CD8(+) lymphocytes in PB using flow cytometry.
  
  
  RESULTS
  We observed improvements in liver fibrosis in four biopsy specimens obtained after splenectomy, in which fibrotic areas significantly decreased from 19.5% to 8.2% (P < 0.05). Increases were also observed in the ratio of CD8(+) cells in PB after splenectomy, which resulted in a significant decrease in the CD4(+) /CD8(+) ratio (P < 0.001). The carcinogenic rate in patients with a CD4(+)  : CD8(+) ratio that decreased by more than 0.5 at 1 month after splenectomy was significantly lower than that in patients with a ratio that decreased by less than 0.5 (P < 0.05).
  
  
  CONCLUSIONS
  Splenectomy may improve liver fibrosis and cause beneficial immunological changes in cirrhotic patients with hepatitis. Improvements in antitumor mechanisms can be also expected.
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan; Department of Surgery, Kurume University School of Medicine, Kurume, Japan; Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Nomura
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kage
authors.forename: Toshirou
authors.initials: T
authors.lastname: Ogata
authors.forename: Reiichirou
authors.initials: R
authors.lastname: Kondou
authors.forename: Hisafumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Kouichi
authors.initials: K
authors.lastname: Ohshima
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yano
keywords: CD4+ cytotoxic T lymphocytes; CD8+ cytotoxic T lymphocytes; liver cirrhosis; liver fibrosis; splenectomy