title: Role of splenectomy for immune thrombocytopenic purpura (ITP) in the era of new second-line therapies and in the setting of a high prevalence of HIV-associated ITP.
abstract: BACKGROUND
  New agents are being used as second-line treatment for immune thrombocytopenia (ITP) and have brought into question the relevance of splenectomy for steroid-resistant ITP.
  
  
  METHODS
  We retrospectively analysed 73 patients who underwent splenectomy for ITP at our institution over an 11-year period. The median follow-up period was 25 months; patients with follow-up of &lt;1 month were excluded. The outcomes of splenectomy were compared in HIV-positive v. HIV-negative patients.
  
  
  RESULTS
  The rate of complete response was 83%, and response was sustained for at least 1 year or until latest follow-up in 80% of patients. Twelve patients were HIV-positive. Splenectomy was laparoscopic in 43 patients (62%) with an overall 16% complication rate. The 90-day mortality rate was 1.38%. There was no statistically significant difference in response or complication rate in the HIV-positive patients. There was a statistically significant (p=0.003) poorer response to splenectomy in the patients with steroid-resistant ITP.
  
  
  CONCLUSIONS
  Splenectomy is effective and safe irrespective of HIV status and remains an appropriate second-line treatment for ITP. Further research is needed to corroborate our finding of lower response in patients who are steroid-resistant, as this might be a subgroup of patients who may benefit from thrombopoietin agonists as second line therapy.
authors.affiliation: Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. katherineantel@gmail.com.
authors.forename: Katherine Rae
authors.initials: KR
authors.lastname: Antel
authors.forename: Eugenio
authors.initials: E
authors.lastname: Panieri
authors.forename: Nicolas
authors.initials: N
authors.lastname: Novitzky
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D015995:Prevalence; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013156:Splenectomy; D013926:Thrombopoietin / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013926:Thrombopoietin