title: Antibody response to a T-cell-independent antigen is preserved after splenic artery embolization for trauma.
abstract: Splenic artery embolization (SAE) is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. The aim of this study was to assess the splenic function of patients who were embolized. A clinical study was performed, with splenic function assessed by examining the antibody response to polysaccharide antigens (pneumococcal 23-valent polysaccharide vaccine), B-cell subsets, and the presence of Howell-Jolly bodies (HJB). The data were compared to those obtained from splenectomized patients and healthy controls (HC) who had been included in a previously conducted study. A total of 30 patients were studied: 5 who had proximal SAE, 7 who had distal SAE, 8 who had a splenectomy, and 10 HC. The median vaccine-specific antibody response of the SAE patients (fold increase, 3.97) did not differ significantly from that of the HC (5.29; P = 0.90); however, the median response of the splenectomized patients (2.30) did differ (P = 0.003). In 2 of the proximally embolized patients and none of the distally embolized patients, the ratio of the IgG antibody level postvaccination compared to that prevaccination was <2. There were no significant differences in the absolute numbers of lymphocytes or B-cell subsets between the SAE patients and the HC. HJB were not observed in the SAE patients. The splenic immune function of embolized patients was preserved, and therefore routine vaccination appears not to be indicated. Although the median antibody responses did not differ between the patients who underwent proximal SAE and those who underwent distal SAE, 2 of the 5 proximally embolized patients had insufficient responses to vaccination, whereas none of the distally embolized patients exhibited an insufficient response. Further research should be done to confirm this finding.
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: D C
authors.initials: DC
authors.lastname: Olthof
authors.affiliation: Department of Infectious Disease Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A J J
authors.initials: AJ
authors.lastname: Lammers
authors.affiliation: Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: E M M
authors.initials: EM
authors.lastname: van Leeuwen
authors.affiliation: Department of Infectious Disease Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J B L
authors.initials: JB
authors.lastname: Hoekstra
authors.affiliation: Department of Infectious Disease Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: I J M
authors.initials: IJ
authors.lastname: ten Berge
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands j.c.goslings@amc.nl.
authors.forename: J C
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D000917:Antibody Formation; D000942:Antigens, Bacterial / Q000276:immunology*; D016175:B-Lymphocyte Subsets / Q000276:immunology; D004621:Embolization, Therapeutic; D004908:Erythrocyte Inclusions; D004912:Erythrocytes / Q000166:cytology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology*; D013154:Spleen / Q000276:immunology* / Q000293:injuries; D013157:Splenic Artery / Q000473:pathology*; D013601:T-Lymphocytes / Q000276:immunology*; D014947:Wounds and Injuries / Q000628:therapy; D055815:Young Adult
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000942:Antigens, Bacterial; D022242:Pneumococcal Vaccines