Transplantation of the spleen

Effect of splenic allograft in human multivisceral transplantation

Tomoaki Kato, Andreas G. Tzakis, Gennaro Selvaggi, Jeffrey Gaynor, Hidenori Takahashi, James Mathew, Rolando Garcia-Morales, Erick Hernandez, Andre David, Seigo Nishida, David Levi, Jang Moon, Eddie Island, Gary Kleiner, Phillip Ruiz

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

OBJECTIVES: To describe the effect of the splenic allograft in human multivisceral transplantation. SUMMARY BACKGROUND DATA: We 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. METHODS: All primary multivisceral recipients who received a donor spleen (N = 60) were compared with those who did not receive a spleen (N = 81). RESULTS: Thirty-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. CONCLUSIONS: Allograft 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.

Original languageEnglish
Pages (from-to)436-444
Number of pages9
JournalAnnals of Surgery
Volume246
Issue number3
DOIs
StatePublished - Sep 1 2007

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Allografts
Spleen
Transplantation
Graft vs Host Disease
Transplants
Control Groups
Incidence
Hemolysis
Platelet Count
Leukocyte Count
Tissue Donors
Infection

ASJC Scopus subject areas

  • Surgery

Cite this

Transplantation of the spleen : Effect of splenic allograft in human multivisceral transplantation. / Kato, Tomoaki; Tzakis, Andreas G.; Selvaggi, Gennaro; Gaynor, Jeffrey; Takahashi, Hidenori; Mathew, James; Garcia-Morales, Rolando; Hernandez, Erick; David, Andre; Nishida, Seigo; Levi, David; Moon, Jang; Island, Eddie; Kleiner, Gary; Ruiz, Phillip.

In: Annals of Surgery, Vol. 246, No. 3, 01.09.2007, p. 436-444.

Research output: Contribution to journalArticle

Kato, T, Tzakis, AG, Selvaggi, G, Gaynor, J, Takahashi, H, Mathew, J, Garcia-Morales, R, Hernandez, E, David, A, Nishida, S, Levi, D, Moon, J, Island, E, Kleiner, G & Ruiz, P 2007, 'Transplantation of the spleen: Effect of splenic allograft in human multivisceral transplantation', Annals of Surgery, vol. 246, no. 3, pp. 436-444. https://doi.org/10.1097/SLA.0b013e3181485124
Kato, Tomoaki ; Tzakis, Andreas G. ; Selvaggi, Gennaro ; Gaynor, Jeffrey ; Takahashi, Hidenori ; Mathew, James ; Garcia-Morales, Rolando ; Hernandez, Erick ; David, Andre ; Nishida, Seigo ; Levi, David ; Moon, Jang ; Island, Eddie ; Kleiner, Gary ; Ruiz, Phillip. / Transplantation of the spleen : Effect of splenic allograft in human multivisceral transplantation. In: Annals of Surgery. 2007 ; Vol. 246, No. 3. pp. 436-444.
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abstract = "OBJECTIVES: To describe the effect of the splenic allograft in human multivisceral transplantation. SUMMARY BACKGROUND DATA: We 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. METHODS: All primary multivisceral recipients who received a donor spleen (N = 60) were compared with those who did not receive a spleen (N = 81). RESULTS: Thirty-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. CONCLUSIONS: Allograft 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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T1 - Transplantation of the spleen

T2 - Effect of splenic allograft in human multivisceral transplantation

AU - Kato, Tomoaki

AU - Tzakis, Andreas G.

AU - Selvaggi, Gennaro

AU - Gaynor, Jeffrey

AU - Takahashi, Hidenori

AU - Mathew, James

AU - Garcia-Morales, Rolando

AU - Hernandez, Erick

AU - David, Andre

AU - Nishida, Seigo

AU - Levi, David

AU - Moon, Jang

AU - Island, Eddie

AU - Kleiner, Gary

AU - Ruiz, Phillip

PY - 2007/9/1

Y1 - 2007/9/1

N2 - OBJECTIVES: To describe the effect of the splenic allograft in human multivisceral transplantation. SUMMARY BACKGROUND DATA: We 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. METHODS: All primary multivisceral recipients who received a donor spleen (N = 60) were compared with those who did not receive a spleen (N = 81). RESULTS: Thirty-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. CONCLUSIONS: Allograft 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.

AB - OBJECTIVES: To describe the effect of the splenic allograft in human multivisceral transplantation. SUMMARY BACKGROUND DATA: We 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. METHODS: All primary multivisceral recipients who received a donor spleen (N = 60) were compared with those who did not receive a spleen (N = 81). RESULTS: Thirty-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. CONCLUSIONS: Allograft 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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