Immune profile of asplenic patients following single or double vaccine administration: A longitudinal cross-sectional study.
OBJECTIVE
Splenectomy poses a lifelong threat for the development of uncontrolled sepsis despite vaccination. As it is impractical to measure the levels of each antibody against 23 most frequent bacterial serotypes, different surrogate markers of immune response should be identified.


METHODS
Forty-eight patients with benign disorders were vaccinated with Pneumo-23 and Act-HIB before or at the day of surgery. The immunological response and opsonization capacity of the patients after splenectomy was analyzed through the quantitative measurement of IgG, IgM, C3, and C4 titers; flow-cytometric analysis of (CD3+) T-lymphocytes and (CD19+) B-lymphocytes; and isolation of CD27+ B cells by immunomagnetic positive selection. Blood samples were drawn at the sixth month and 5 and 7 years after surgery.


RESULTS
The mean follow-up period was 98.4 months. All the patients in this series had normal IgG, C3, C4 levels and a normal distribution of CD19+ B-cells and CD8+ T-cells in three follow-up periods. Moreover, C3 levels markedly improved to 133.5±37.3 mg/dL at 5 years and remained stable thereafter. CD19+ B-lymphocyte values have progressively improved to the normal range in 98% patients at 7 years. Further, low levels of CD27+ B-cell population (memory cells) was observed in only 12.5% patients at the last follow-up. Adequate seroconversion of IgG, IgM with normal C3, C4, and CD19+ B-cell levels were accomplished in almost all patients. Early postoperative death and late overwhelming infections did not occur.


CONCLUSIONS
Our results are indicative of the resumption of the immune function following Pneumo-23 and Act-HIB administrations, instigated by the probable activation of B cells and adequate production of C3, C4, IgG, and IgM antibodies in remote lymphoid tissues.
Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Sait Murat
SM
Doğan
Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Ahmet
A
Aykas
Clinic of Infectious Diseases, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Evrim Şefika
EŞ
Yücel
Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Gökalp
G
Okut
Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Cenk
C
Şimşek
Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Kürşat
K
Çayhan
Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Baha
B
Zengel
Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
Adam
A
Uslu
CD19; CD3; Splenectomy; haemophilus influenza prophylaxis; opsonins; pneumococcal prophylaxis