Postsplenectomy sepsis 10 years or more after operation.

Evans, D. I. K.

doi:10.1136/jcp.38.3.309

Cited by 79 publications

(33 citation statements)

References 25 publications

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“…Patients with HS received, on the average, 0.32 units of blood per year of life before surgery but only 0.02 units of blood per year of life after surgery. During the follow-up period, only 5 …”

Section: Transfusion Requirementsmentioning

confidence: 99%

“…2,3 Increased awareness that splenectomized patients face a lifelong risk of overwhelming life-threatening infections has dampened enthusiasm for the routine use of total splenectomy for the management of HS. [4][5][6][7] The phagocytic activity of splenic macrophages and the synthesis of antipolysaccharide antibodies by splenic B-lymphocytes both are necessary to mount an optimal defense against infections. Infectious complications due to circulating encapsulated bacteria can occur irrespective of age and of the time interval after the surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

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Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis

Bader-Meunier

Gauthier

Archambaud

et al. 2001

Blood

145

112

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Clinical manifestations of hereditary spherocytosis (HS) can be abrogated by splenectomy. However, concerns exist regarding exposure of patients to a lifelong risk for overwhelming infections and, to a lesser extent, to vascular complications after total splenectomy. In the search for alternative treatment modalities, we assessed, in a previous pilot study, the potential usefulness of subtotal splenectomy in a small population of patients. During a mean follow-up period of 3.5 years, subtotal splenectomy was shown to be effective in decreasing the hemolytic rate, while maintaining the phagocytic function of the spleen. In the current study, we evaluated the clinical and biologic features of 40 patients with HS who underwent subtotal splenectomy and were monitored for periods ranging from 1 to 14 years. The beneficial effect of subtotal splenectomy included a sustained decrease in hemolytic rate and a continued maintenance of phagocytic function of the splenic remnant. However, mild-to-moderate hemolysis was persistent and accounted for secondary gallstone formation and aplastic crisis in a small subset of patients. Surprisingly, regrowth of the remnant spleen did not seem to have a major impact on the beneficial outcomes of these individuals. Our results suggest that subtotal splenectomy appears to be a reasonable treatment option for management of patients with HS, especially young children.

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Section: Transfusion Requirementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis

Bader-Meunier

Gauthier

Archambaud

et al. 2001

Blood

145

112

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“…Asplenic patients are therefore at increased risk for invasive infections with S. pneumoniae (13). Although most infections occur within the first few years after splenectomy, the risk of overwhelming postsplenectomy infections is lifelong (9,36). Therefore, vaccination against S. pneumoniae is indicated for this group.…”

mentioning

confidence: 99%

Pneumococcal Conjugate Vaccines Overcome Splenic Dependency of Antibody Response to Pneumococcal Polysaccharides

Breukels

Zandvoort²,

Dobbelsteen

et al. 2001

Infect Immun

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Protection against infections with Streptococcus pneumoniae depends on the presence of antibodies against capsular polysaccharides that facilitate phagocytosis. Asplenic patients are at increased risk for pneumococcal infections, since both phagocytosis and the initiation of the antibody response to polysaccharides take place in the spleen. Therefore, vaccination with pneumococcal polysaccharide vaccines is recommended prior to splenectomy, which, as in the case of trauma, is not always feasible. We show that in rats, vaccination with a pneumococcal conjugate vaccine can induce good antibody responses even after splenectomy, particularly after a second dose. The spleen remains necessary for a fast, primary response to (blood-borne) polysaccharides, even when they are presented in a conjugated form. Coadministration of a conjugate vaccine with additional nonconjugated polysaccharides of other serotypes did not improve the response to the nonconjugated polysaccharides. We conclude that pneumococcal conjugate vaccines can be of value in protecting asplenic or hyposplenic patients against pneumococcal infections.Protection against infections with encapsulated bacteria such as Streptococcus pneumoniae depends on the presence of antibodies against capsular polysaccharides. These serotypespecific antibodies facilitate phagocytosis, the main mode of host defense against S. pneumoniae. The spleen is an important organ in the immune response to S. pneumoniae, since it contains both antibody-producing B cells and phagocytes (4, 26). Asplenic patients are therefore at increased risk for invasive infections with S. pneumoniae (13). Although most infections occur within the first few years after splenectomy, the risk of overwhelming postsplenectomy infections is lifelong (9, 36). Therefore, vaccination against S. pneumoniae is indicated for this group. At present, the vaccine available for this aim is the 23-valent pneumococcal polysaccharide (PPS) vaccine (1). The immunogenicity of PPS vaccine in splenectomized patients has been assessed in a number of trials. Some studies have shown the effectiveness of vaccination in inducing protective concentrations of specific antibodies (5, 10, 24, 33), while others have shown limited serological responses (15). As the initiation of the antibody response to polysaccharides seems to depend on the presence of splenic tissue, and in particular on a functional marginal-zone B-cell compartment (3,14,18,34), it may be expected that polysaccharide vaccines are of limited use in asplenic patients.The physical coupling of a polysaccharide to a carrier protein greatly improves the immunogenicity of the polysaccharide, a principle first described in 1929 (11). Conjugated polysaccharides overcome the antipolysaccharide unresponsiveness in early life (2, 8), which is thought to be due to a still immature splenic marginal-zone B-cell compartment (2). The induction of antipolysaccharide antibodies by conjugate vaccines at a young age suggests that conjugates might initiate the antipolysaccharide anti...

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“…Despite vaccinations, fulminant bacterial sepsis carries a high risk of morbidity and mortality, especially in immunocompromised patients. The risk is greatest in the early months and years after splenectomy, but a period of as long as 45 years after the procedure has been reported in the literature [19] .…”

Section: Splenectomymentioning

confidence: 99%

Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

Sibulesky

Nguyen

Paz‐Fumagalli

et al. 2009

WJG

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Hepatitis C is the most common indication for orthotopic liver transplantation in the United States. Unfortunately, hepatitis C recurs universally in the transplanted liver and is the major cause of decreased graft and patient survival. The combination therapy of interferon and ribavirin has been shown to be the most effective therapy for recurrent hepatitis C. However, pre-and post-transplant hypersplenism often precludes patients from receiving the antiviral therapy. Splenectomy and partial splenic embolization are the two invasive modalities that can correct the cytopenia associated with hypersplenism. In this report we review the two treatment options, their associated outcomes and complications.

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Postsplenectomy sepsis 10 years or more after operation.

Cited by 79 publications

References 25 publications

Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis

Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis

Pneumococcal Conjugate Vaccines Overcome Splenic Dependency of Antibody Response to Pneumococcal Polysaccharides

Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

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