OutcomeInclusion of Spleen in Pediatric Multivisceral Transplantation
Section snippets
Patients and methods
Beginning in 2003, the spleen was transplanted together with multivisceral transplantation in 17 children under daclizumab induction therapy (spleen group). The results were compared to 23 children who received multivisceral transplantation without the spleen (control group) with the same immunosuppression regimen.
Results
Patient demographics are summarized in Table 1. Median age of the 17 patients who received a spleen was 0.80 years (range 0.54–1.66). They included 10 boys and 7 girls. Their causes of intestinal failure were gastroschisis (n = 5), necrotizing enterocolitis (n = 3), intestinal atresia (n = 3), volvulus (n = 2), Hirschsprung’s disease (n = 2), and megacystis microlocolon syndrome (n = 2).
Platelet counts at 30 and 60 days posttransplant were significantly lower in the spleen group. Average values
Discussion
The spleen is the largest single secondary lymphoid organ and the most important organ of the reticuloendothelial system. The organ plays a role in both adaptive and innate immune responses. Healthy individuals that have undergone posttraumatic splenectomy have long-term impairment of humoral and cellular immunity.6 These patients are extremely susceptible to encapsulated bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type B. The polysaccharide
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Cited by (6)
Temporary Deceased Donor Splenic Transplant Prior to Intestinal Transplantation: A New Strategy for Desensitization?
2021, Transplantation ProceedingsCitation Excerpt :This experience was in the setting of variable induction immunosuppression, prior to the standardization of DSA testing, and all patients were FXM negative. In additional analyses, rejection-free survival was prolonged, but the risk of graft-vs-host disease is potentially augmented [18]. Our patient responded well both serologically and clinically to temporary splenic transplantation, along with standard posttransplant desensitization protocol and maintenance immunosuppression.
Pediatric Abdominal Organ Transplantation. Current Indications, Techniques, and Imaging Findings.
2016, Radiologic Clinics of North AmericaCitation Excerpt :In the setting of splenectomy, the patient is susceptible to encapsulated bacteria and thrombocytosis. However, when the donor spleen is included, higher rates of graft-versus-host disease (GVHD) are observed.68,69 One group has proposed preservation of the native spleen to avoid the asplenic state and the higher rates of GVHD associated with a donor spleen.70
Preservation of the native spleen in multivisceral transplantation
2013, Pediatric TransplantationCombined en bloc liver/pancreas transplantation in two different patients
2009, World Journal of GastroenterologyIntestinal transplantation: Current improvements and perspectives
2007, Current Opinion in Organ Transplantation