• Annals of surgery · Sep 2007

    Transplantation of the spleen: effect of splenic allograft in human multivisceral transplantation.

    • Tomoaki Kato, Andreas G Tzakis, Gennaro Selvaggi, Jeffrey J Gaynor, Hidenori Takahashi, James Mathew, Rolando Garcia-Morales, Erick Hernandez, Andre David, Seigo Nishida, David Levi, Jang Moon, Eddie Island, Gary Kleiner, and Phillip Ruiz.
    • Departments of Surgery, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA. tkato@med.miami.edu
    • Ann. Surg. 2007 Sep 1; 246 (3): 436-44; discussion 445-6.

    ObjectivesTo describe the effect of the splenic allograft in human multivisceral transplantation.Summary Background DataWe performed transplants of the spleen as part of a multivisceral graft in an attempt to decrease both the risk of infection from an asplenic state and the risk of rejection by a possible tolerogenic effect. To our knowledge, this is the first report of human splenic transplantation in a large series.MethodsAll primary multivisceral recipients who received a donor spleen (N = 60) were compared with those who did not receive a spleen (N = 81).ResultsThirty-five of 60 (58%) are alive in the spleen group, and 39 of 81 (48%) are alive in control group (P = 0.98). In univariate analysis, splenic recipients showed superiority in freedom-from-any rejection (P = 0.02) and freedom-from-moderate or severe rejection (P = 0.007). No significant differences were observed in analyses of infectious complications between the spleen and control groups. Both platelet and leukocyte counts became normal in splenic patients, whereas these counts were significantly increased in nonsplenic recipients. Observed incidence of graft versus host disease (GVHD) was 8.25% (5 of 60) in the spleen group and 6.2% (5 of 81) in the control group (P = 0.70). Increased incidence of autoimmune hemolysis was observed in the spleen group.ConclusionsAllograft spleen can be transplanted within a multivisceral graft without significantly increasing the risk of GVHD. The allogenic spleen seems to show a protective effect on small bowel rejection. Further investigation with longitudinal follow-up is required to precisely determine the immunologic and hematologic effects of the allograft spleen.

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