K. A. Lewellen1, J. Butler1, M. House1, T. Nguyen1, T. Maatman1, N. Zyromski1 1Indiana University School Of Medicine, Department Of Surgery, Division Of Surgical Oncology, Indianapolis, IN, USA
Introduction:
Splenectomy is commonly performed for hematologic disease, for splenic trauma, and during pancreatectomy. Overwhelming post-splenectomy infection (OPSI), first described in 1952, remains a significant cause of morbidity and mortality in asplenic patients. The incidence of OPSI ranges from under 1% to 3%, with mortality rates of 50-70%. Splenic autotransplantation was introduced to mitigate the risk of OPSI. Studies on splenic autotransplantation are few and the data heterogenous. Therefore, we sought to systematically review the literature on splenic autotransplantation. We hypothesize that splenectomy with splenic autotransplantation confers greater immunologic protection than splenectomy alone.
Methods:
Systematic review of the literature indexed on PubMed was searched according to keywords associated with the topic, including spleen, autotransplantation, reimplantation, and splenectomy. A total of 504 results were initially obtained and screened. Reviews, editorials, commentaries, and other studies not relevant to splenic autotransplantation, infection, surgical outcomes, or immunologic function were excluded. 150 studies were included in the analysis. Subgroup descriptive statistics based on species of subject population were applied to generalize results.
Results:
Among 150 articles included, 43 (29%) studied human subjects, and the remainder were preclinical animal studies (rat [40%], mice [11%], dogs [8%], rabbit [7%], pigs [5%], and sheep [1%]). The literature included case reports, cohort studies, retrospective reviews, and prospective trials. Among human studies, 53% suggested an immunologic advantage with splenic autotransplant over splenectomy alone. The median sample size of the human studies was 22 patients, and 72% were conducted in the trauma population. The most common method of investigating splenic autografts was radiologically (65% of studies). Only five studies investigated the response to either a vaccine or infectious challenge (Table 1).
Conclusion:
Review of the splenic autotransplantation literature demonstrates substantial heterogeneity in study population, design, quality, and measured endpoints. The suggestion of immunologic benefit of splenic autotransplantation reinforces the need for further work to be done to mitigate the lifetime risk of OPSI in splenectomized patients.
