Long‐term decrease of CD4⁺CD45RA⁺ T cells and impaired primary immune response after post‐traumatic splenectomy

Abstract

Congenital or acquired absence of the spleen and functional hyposplenism are associated with abnormalities of host defence such as an increased susceptibility to infection with encapsulated bacteria. The effects of the lack of the spleen on cell‐mediated immunity are largely unknown. In the present study we have investigated peripheral blood lymphocyte subpopulations in healthy adults who had undergone splenectomy because of severe abdominal trauma > 4 years before the study. The results show a significant reduction in the percentage of CD4+ T cells due to a selective and long‐term decrease in the percentage of CD4+CD45RA+ lymphocytes, the CD4+ T‐cell subset mainly involved in primary immune responses to newly encountered antigens. Levels of the reciprocal CD45RO+CD4+ T‐cell subset were comparable between splenectomized and control individuals, as were lymphoproliferative responses and IFN‐gamma production to recall antigens. Decreased levels of CD4+CD45RA+ cells were accompanied by an impairment in primary immune responsiveness, as assessed by investigating T‐cell proliferation to stimulation with keyhole limpet haemocyanin and by measuring antibody responses following primary immunization with a clinically relevant T‐dependent antigen, hepatitis A vaccine, in vivo. These findings suggest a possible role of the spleen in the generation, maintenance and/or differentiation of naive, unprimed T cells or their precursors, which might have a possible functional relevance for primary immune responses following splenectomy.

The Current State of Minimally Invasive Distal Pancreatectomy

“…The spleen does carry immunologic benefit and there is an increased risk of overwhelming sepsis following its removal [57][58][59][60][61][62][63][64][65]. Furthermore, concomitant splenectomy has been shown in some series to be a significant risk factor for complications, including pancreatic fistulae [66][67][68], although findings to the contrary have been published elsewhere [69].…”

Can partial splenectomy preserve humoral immunity in pediatric patients? Risks and benefits of partial splenectomy

“…(17,18) Van Wyck et al, have reported that preservation of a splenic remnant, approximately one-third the size of the normal spleen, seems critical to maintaining this protective effect in the rat. (19)(20)(21) Several authors have confirmed the effectiveness of partial splenectomy in the treatment of children with mild to moderate HS, reserving total splenectomy for severe disease. (14) Partial splenectomy is a viable option for selected patients with HS leading to improvement in hematologic and clinical abnormalities.…”

Effect of non-operative management (NOM) of splenic ruptureversussplenectomy on the distribution of peripheral blood lymphocyte populations and cytokine production by T cells

“…A previous study investigating a similar age group of splenectomized individuals found also a long-term reduction of the percentage of naive CD4 + T cells, and linked this reduction to primary T cell defects resulting to a weak response to hepatitis A vaccination [12].…”

“…Few studies have addressed the issue of alterations in T cell immunity in splenectomized individuals. Two published studies reported that splenectomized patients (SP) have impaired primary and memory immune responses to antigens that elicit T cell-dependent responses, indicating that T cell-mediated immunity is also defective in these patients [12,13].…”