American Surgical Association
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Transplantation of the Spleen - Effect of Splenic Allograft In Human Multivisceral Transplantation
Tomoaki Kato*, Andreas G Tzakis, Gennaro Selvaggi*, Seigo Nishida*, Jeffrey J Gaynor*, Andre David*, James Mathew*, Jang Moon*, David Levi*, Phillip Ruiz*
University of Miami, Miami, FL

OBJECTIVE(S): We performed transplants of the spleen as part of multivisceral graft in an attempt to reduce risk of infection from asplenic state as well as to decrease incidence of rejection by its possible tolerogenic effect. To our knowledge, this is the first report of human splenic transplant in a large series.
METHODS: All multiviceral recipients who received donor spleen (N=55, spleen group) were compared with those who did not receive spleen (N=77, no spleen group). Logrank test p-values from univariable analysis were displayed unless specified otherwise.
RESULTS: Thirty-four of 55(62%) are alive in the spleen group (median follow-up: 384 days), and 36 of 77(42%) are alive in no spleen group(p=NS). Splenic recipients were less likely to develop moderate or severe rejection of the intestinal allograft (p=0.02). The mean number of infection episodes per patient during the first three months was less in splenic recipients (2.14 vs 2.96, t-test:p=0.02), and these patients were less likely to have fungal infection(p=0.049). Both platelet and leukocyte counts were normal in splenic patients whereas these counts were significantly increased in non-splenic recipients. Five splenic recipients(9%) and 5 non-splenic recipients(6%) developed GVHD(p=NS). One(2%) splenic patient and 9(11%) non-splenic patients developed PTLD(p=NS). Two transplanted spleens were removed for GVHD(n=1) and refractory ITP(n=1). Both patients had resolution of symptoms and are currently alive.
CONCLUSIONS: Allograft spleen in the multivisceral graft appears to have shown its function of normalizing peripheral blood cell counts, improving protection against infection, and lowering intestinal allograft rejection.

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