Impact of total splenectomy on peripheral lymphocytes and their subsets in patients with hypersplenism associated with cirrhotic portal hypertension

Lv, Yunfu; Wu, Huimeng; Lau, Wan Yee; Zheng, Jinfang; Wu, Junzhen; Zeng, Min

doi:10.1038/s41598-021-00692-x

Cited by 7 publications

(5 citation statements)

References 41 publications

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“…A low platelet count < 30 × 10 9 /L would theoretically be assigned a score of 5 based on this scoring system, indicating that surgery is contraindicated. However, the cause of the platelet reduction would need to be considered because restoration of the platelet count to normal would be possible by performing surgery to remove an enlarged spleen [ 47 , 48 ]. Therefore, we did not include platelet reduction in the scoring and grading of coagulation dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients

Liu

Li³

et al. 2023

Disease Markers

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Objective. Patients with cirrhosis and splenomegaly often have coagulation dysfunction which affects treatment and prognosis. This study explores the status, grading, and treatment strategies of coagulation dysfunction in patients with liver cirrhosis and splenomegaly. Methods. A retrospective cohort study was conducted on the clinical data on consecutive patients with cirrhosis and splenomegaly treated at Hainan General Hospital, China, from January 2000 to December 2020. Starting research in January 2022. Results. Among 1522 patients included into this study, 297 (19.5%) patients had normal results in all five coagulation tests (prothrombin time, prothrombin activity, activated partial thromboplastin time, thrombin time, and fibrinogen), and 1225 (80.5%) had coagulation dysfunction in at least one of these tests. There were significant differences ( P < 0.05 ) in treatment efficacy on these patients for three of these five coagulation tests, with the exception of prothrombin activity and thrombin time. When coagulation dysfunction was classified into grades I, II, and III based on scores from the three significant coagulation tests, prothrombin time, activated partial thromboplastin time, and fibrinogen, significant differences in surgical outcomes were found among the three grades of coagulation dysfunction and between grades I and III ( P < 0.05 ). The operative mortality rate in patients with grade III in treating liver cancer, portal hypersplenism, and/or splenomegaly was 6.5%. There was no significant difference between patients with grades I and II ( P > 0.05 ). Conclusions. Approximately, 80% of patients with liver cirrhosis and splenomegaly had coagulation dysfunction. Surgery is feasible for grade I and II patients. For grade III patients, nonsurgical treatment should be given first, and surgery should only be considered when the coagulation function returns to normal or near-normal levels after treatment. This trial is registered with MR-46-22-009299.

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Section: Discussionmentioning

confidence: 99%

Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients

Liu

Li³

et al. 2023

Disease Markers

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“…Zhang et al showed that patients with cirrhosis and hypertension have improved PLT counts and aggregation function after laparoscopic SPD compared to those without surgery [ 12 ]. Patients who underwent total splenectomy showed a significant increase in the total lymphocyte count, including B lymphocytes, total T lymphocytes, and their subsets, which improved immune function as a result [ 13 ]. Moreover, splenectomy not only reduces PH but also has positive effects on liver metabolism [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of long-term outcomes of splenectomy with periesophagogastric devascularization and transjugular intrahepatic portosystemic shunt in treating cirrhotic portal hypertension patients with recurrent variceal bleeding

Zhu

Wang

Yun

et al. 2023

Langenbecks Arch Surg

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Purpose Transjugular intrahepatic portosystemic shunt (TIPS) and splenectomy with periesophagogastric devascularization (SPD) are widely used to treat cirrhotic portal hypertension (PH) and prevent variceal rebleeding. However, direct comparisons between these two approaches are rare. This study was designed to compare the long-term outcomes of TIPS and SPD in patients with cirrhotic PH and variceal rebleeding. Methods The study included cirrhotic PH patients with a history of gastroesophageal variceal bleeding between 18 and 80 years of age who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to January 2022. Patients were enrolled into two groups according to TIPS or SPD was performed. Baseline characteristics were matched using propensity score matching (PSM). Results A total of 230 patients underwent TIPS, while 184 underwent SPD. PSM was carried out to balance available covariates, resulting in a total of 83 patients in the TIPS group and 83 patients in the SPD group. Patients in SPD group had better liver function during 60 months follow-up. Five-year overall survival rates in SPD group and TIPS group were 72 and 27%, respectively, at 2 years were 88 and 86%, respectively. The 2- and 5-year freedom from variceal rebleeding rates were 95 and 80% in SPD group and 80 and 54% in TIPS group. Conclusions SPD is clearly superior to TIPS in terms of OS and freedom from variceal rebleeding in patients with cirrhotic PH. In addition, SPD improved liver function in patients with cirrhotic PH.

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“…Total splenectomy was performed for treatment, and general anesthesia was performed under endotracheal intubation. [ 6 , 7 ]…”

Section: Methodsmentioning

confidence: 99%

Changes to the myocardial enzyme spectrum in patients with different degrees of spleen injury and their clinical value

Han

Zheng-wu

et al. 2022

Medicine

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To investigate the changes to the myocardial enzyme profile and its clinical value in patients with different degrees of spleen injury. Of all patients who underwent total splenectomy due to trauma-induced spleen injury from January 2019 to January 2022 were selected, 70 patients with grade III and IV spleen injuries were selected as the experimental group. In addition, 70 patients with grade I and II were selected as control group 1, and another 70 patients as control group 2. The levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) in the 3 groups were detected before (T0) and on the 1st day (T1) after surgery, on the 3rd day (T2) and on the 7th day (T3) after surgery, and on the 14th day (T4) after surgery, respectively, to analyze the relationship with the severity of spleen injury. The spleen injury experimental group, control group 1, and control group 2 were all cured and discharged after corresponding treatment, and there was no myocardial infarction within 3 months of hospitalization and discharge follow-up. The experimental group had higher CK, CK-MB, and LDH than control group 1 and control group 2 at the same time point from T0 to T4 (P<.05); the CK and CK-MB of control group 1 were higher than those of control group 2 at the same time points from T0 to T4 (P < .05), the LDH at points T0 to T2 was higher than that of control group 2 (P < .05), and the LDH was lower at points T3 and T4. Compared with T0 in the same group, CK, CK-MB, and LDH at T1 to T4 in the 3 groups were all lower than those at T0 (P < .05). The early peripheral blood myocardial enzyme spectrum of patients with different degrees of spleen injury is increased, and the increase of myocardial enzyme spectrum is positively correlated with the severity of spleen injury, suggesting that patients with traumatic spleen injury may have myocardial damage in the early stage, and should be treated as soon as possible.

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Impact of total splenectomy on peripheral lymphocytes and their subsets in patients with hypersplenism associated with cirrhotic portal hypertension

Cited by 7 publications

References 41 publications

Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients

Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients

Comparison of long-term outcomes of splenectomy with periesophagogastric devascularization and transjugular intrahepatic portosystemic shunt in treating cirrhotic portal hypertension patients with recurrent variceal bleeding

Changes to the myocardial enzyme spectrum in patients with different degrees of spleen injury and their clinical value

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