Elsevier

Transplantation Proceedings

Volume 38, Issue 6, July–August 2006, Pages 1709-1710
Transplantation Proceedings

Outcome
Inclusion of Spleen in Pediatric Multivisceral Transplantation

https://doi.org/10.1016/j.transproceed.2006.05.059Get rights and content

Abstract

Inclusion of the donor spleen may be beneficial for small children who receive multivisceral transplantation (MVT) because asplenia is associated with increased risk of bacterial sepsis. Beginning in 2003, the spleen was transplanted together with multivisceral transplantation in 17 children under daclizumab induction (spleen group). The results were compared to 23 children who received multivisceral transplantation without the spleen (control group) with the same immunosuppression regimen. Median age of 17 patients who received a spleen was 0.80 years (range 0.54–1.66). Platelet counts at 30 and 60 days posttransplant were significantly lower in the spleen group (average values: day 30: 399,000 vs 636,000, P = .015; day 60: 413,000 vs 622,000, P = .0056). WBC counts at 30 and 60 days posttransplant were also decreased in the spleen group but the difference was not statistically significant. Median rejection-free survival was 205 days in the spleen group and 101 days in the control group (P = NS). Median length of hospital stay was 39 days in the spleen group and 61 days in the control group. With a median follow-up of 398 days (spleen group) and 1232 days (control group), 3 of 17 (17%) in the spleen group developed graft versus host disease (GVHD), whereas 1 of 23 (4.5%) in control group did (P = NS). In one patient in each group, GVHD was fatal. No patient developed posttransplant lymphoproliferative disorder (PTLD) in the spleen group, whereas 4 of 23 (17%) in the control group developed PTLD. One-year patient survival was 84% in the spleen group and 86% in the control group. Recipients of the spleen as part of a multivisceral graft had significantly lower platelet counts. Rejection-free survival may be prolonged, but the risk of GVHD may be increased.

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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