Preservation of splenic function by autotransplantation of traumatized spleen in man

Abstract

Splenectomy is known to increase the risk of overwhelming bacterial infection. Characteristically, there is a decrease in immunoglobulin IgM, properdin, and T-lymphocytes; impaired primary antibody response to antigen challenge; an altered opsonic function; and a tuftsin deficiency. Because the spleen is important in host defense, preservation of traumatized splenic tissue has been advocated. Splenic autotransplantation has been suggested as a method of preserving function, and this concept is supported by experiments in animals. The present study describes autotransplantation of the traumatized spleen in human beings for the preservation of splenic function. Four patients operated on for blunt abdominal trauma required total splenectomy for hemostasis and were deemed suitable candidates for autotransplantation of the splenic tissue. In each, thinly sliced segments of spleen (roughly 20 gm.) were placed in a previously fashioned omental pouch. All patients survived without complications. Postoperative studies included blood and platelet counts, cell morphology, determination of serum immunoglobulin levels, and splenic scans. Four weeks postoperatively, Howell-Jolly bodies and target cells had disappeared from the red cells. Platelet counts returned to normal range. Initially low IgM and C3 complement levels increased to normal. Scans at 8 weeks confirmed the presence of functioning splenic tissue. Autotransplantation of the spleen is a safe method for preserving splenic function when total splenectomy is mandatory for hemostasis.