Studies in animals and clinical experience in patients have demonstrated that splenectomy may lead to an increased susceptibility to infection. The infections are usually caused by encapsulated bacteria such as penumococcus. It has been shown in a variety of experimental animals that autotransplanted splenic tissue is capable of regenerating into implants that are microscopically indistinguishable from normal spleen and of restoring a number of normal splenic functions. The response to intravenous challenge with Streptococcus pneumoniae, type 25, was therefore studied in control, asplenic, and autotransplanted Sprague-Dawley rats. Despite previous observations that a number of immune functions can be restored in this animal model by autotransplanted splenic tissue, the present study indicates that splenic tissue autotransplants do not restore the ability to resist intravenous pneumococcal challenge.

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IntroductionChronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by pulmonary endarterectomy (PEA). Despite this a significant proportion of patients offered PEA decline surgery.ObjectiveTo compare long term survival and prognostic indicators in patients with technically operable CTEPH who underwent PEA and those who declined surgery.MethodsData were collected for consecutive, treatment-naïve patients diagnosed with CTEPH between 2001 and 2014 identified from the ASPIRE-pulmonary-hypertension-registry.ResultsOf 588 patients with CTEPH, 368 patients were offered surgery. Seventy six percent (n=281) underwent PEA, 20% (n=72) declined surgery and 4% (n=15) were planned to undergo surgery. Five year survival was superior in patients undergoing PEA at 83% compared to patients who declined surgery at 56% (p=0.001, log-rank test). In patients who were offered surgery, mixed venous oxygen saturation (SvO2) (p=0.003), gas transfer (DLco) (p=0.042), history of coronary artery disease (p=0.031) and patient choice (declining surgery) (p<0.001) were independent predictors of mortality. For patients who declined surgery a median threshold of DLco 62%, right atrial pressure 11 mmHg, and SvO262% the positive and negative predictive values for 3 year survival were 31% and 100%, 32% and 95% and 30% and 97%, respectively.Abstract P183 Figure 1ConclusionIn a cohort of consecutive patients with CTEPH the long-term survival of patients undergoing PEA is excellent and superior to patients declining surgery and strongly favours surgical intervention in eligible patients. More work is required to understand factors influencing decision making in CTEPH and to ensure that patients are counselled and supported to make informed decisions.

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