Posttraumatic Autotransplantation of Spleen Tissue

Mizrahi, Shlomo; Bickel, Amitai; Haj, Mahmud; Lunski, Ida; Shtamler, B

doi:10.1001/archsurg.1989.01410070123025

Cited by 21 publications

(13 citation statements)

References 20 publications

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“…This has been shown to have a dramatic effect in increasing specific antibody responses to pneumococcal vaccination, as well as normalizing IgM levels, presumably, thereby decreasing susceptibility to infection. (64)(65)(66) The lack of the spleen has more dramatic consequences in the newborn. The incidence of congenital asplenia is very low and probably underestimated, because most children born without spleen die of infection during the first months of life and it has been suggested that congenital asplenia may be an unrecognized cause of sudden unexpected death in infancy.…”

Section: The Spleen's Role In Limiting Bacterial Infectionmentioning

confidence: 99%

Development and function of the mammalian spleen

et al. 2007

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The vertebrate spleen has important functions in immunity and haematopoiesis, many of which have been well studied. In contrast, we know much less about the mechanisms governing its early embryonic development. However, as a result of work over the past decade-mostly using knockout mice--significant progress has been made in unravelling the genetic processes governing the spleen's early development. Key genetic regulators, such as Tlx1 and Pbx1, have been identified, and we know some of the early transcriptional hierarchies that control the early patterning and proliferation of the splenic primordium. In mouse and humans, asplenia can arise as a result of laterality defects, or the spleen can be absent with no other discernible abnormalities. Surprisingly, given the spleen's diverse functions, asplenic individuals suffer no major haematopoietic or immune defects apart from a susceptibility to infection with encapsulated bacteria. Recent evidence has shed light on a previously unknown role of the spleen in the development and maintenance of specific B cell populations that are involved in the initial response to infection caused by encapsulated bacteria. The lack of these populations in asplenic mice and humans may go some way to explaining this susceptibility.

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Section: The Spleen's Role In Limiting Bacterial Infectionmentioning

confidence: 99%

Development and function of the mammalian spleen

et al. 2007

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“…Simple splenectomy in Sugiura operation may induce a series of important alterations in the immune response. Autotransplantation of splenic fragments after splenectomy has been advocated as a method of retaining normal splenic immune function in the treatment of splenic trauma or splenomegaly caused by hematologic disorder [13][14][15]. However, it is unclear whether preservation of splenic tissue with splenomegaly will be beneficial to the patients with portal hypertension and cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension (26 years clinical observation)

et al. 2007

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The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated. In this study, we evaluated the effectiveness of a new treatment strategy: splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects: clinical observation, splenic immunology and portal dynamics. From 1979 to 2005, 274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes, which were then compared with those of the traditional surgery treatment. From 1999 to 2002, a randomized control trial (RCT) was performed on 40 patients to compare their immune function after operation. From 1994 to 2004, another RCT was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography (3D DEC MRA) investigation after operation. Among 274 patients (mean age 41.8 years), the emergency operative mortality (4.4%), selective operative mortality (2.2%), complication rate (17.9%), morbidity of hepatic encephalopathy (<1%), bleeding rate of portal hypertension gastritis (PHG) (9.1%), and morbidity of hepatic carcinoma (8%) were similar to those under traditional operation; the spleen immunology function (Tuftsin, IgM) decreased among the groups 2 months after operation. Through 3D DCE MRA, the cross section area, the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups, the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group. Splenic auto transplantation and esophageal transection anastomosis are a safe, effective, and reasonable treatment strategy for portal hypertension with varicial bleeding. It can not only correct hypersplenism but also completely stanch blood, and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

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“…Autotransplantation of splenic fragments after splenec-tomy has been advocated as a method of retaining normal splenic immune function in the treatment of massive splenic trauma or splenomegaly caused by hematologic disorders. [6][7][8][9] However, it remains equivocal whether splenic autotransplantation may help maintain splenic immune function in patients with portal hypertension and cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…Autotransplantation of splenic fragments after splenectomy has been advocated as a method of retaining normal splenic immune function in the treatment of splenic trauma or splenomegaly caused by hematologic disorder. [6][7][8][9] However, it is unclear whether preservation of splenic tissue with splenomegaly will be beneficial to the patients with portal hypertension and cirrhosis. The results of our randomized controlled study show that modified Sugiura surgery plus splenic autotransplantation is a safe procedure in patients with portal hypertension and cirrhosis.…”

Section: Commentmentioning

confidence: 99%

The Value of Partial Splenic Autotransplantation in Patients With Portal Hypertension

Zhang

Chen²,

Kaiser³

et al. 2002

Arch Surg

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Setting: University hospital. Patients: Twenty patients (19 men and 1 woman; aged 33-80 years) suffering from portal hypertension and liver cirrhosis were randomly allocated into 2 groups. Each group consisted of 10 patients. Interventions: All patients underwent modified Sugiura operation. In the control group, splenectomy was performed, while partial splenic autotransplantation into the retroperitoneal space was additionally completed in the splenic autotransplantation group. Main Outcome Measures: Serum tuftsin and IgM were measured preoperatively and 2 months after surgery. Dynamic scintigraphy with technetium Tc 99m-labeled heat-damaged erythrocytes was performed at 2-month intervals during the 8-month follow-up. Results: There was no statistical difference in the mortality of the groups. The preoperative levels of serum tuftsin and IgM showed no statistical difference between groups. However, although these measures had decreased remarkably in the control group 2 months after operation (PϽ.001 for serum tuftsin; P =.04 for serum IgM), they remained stable in the splenic autotransplantation group (P =.25 for serum tuftsin; P =.12 for serum IgM). Four patients within the splenic autotransplantation group showed positive scanning of the transplanted splenic fragment during follow-up, whereas there was no positive scanning in the control group. RESULTS MORBIDITY AND MORTALITY An 80-year-old patient from the splenic autotransplantation group, who had had severe chronic obstructive pulmonary disease for more than 30 years, died of

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Posttraumatic Autotransplantation of Spleen Tissue

Cited by 21 publications

References 20 publications

Development and function of the mammalian spleen

Development and function of the mammalian spleen

Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension (26 years clinical observation)

The Value of Partial Splenic Autotransplantation in Patients With Portal Hypertension

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