Implication of the Spleen in Pediatric Multivisceral Transplantation

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Abstract

Objective

Analyze the role of spleen in pediatric intestinal/multivisceral transplantation and its variants.

Material and Methods

We analyzed pediatric patients transplanted in our unit from October'99 to May'15. Comorbidities (cellular, humoral and chronic rejection, graft-versus-host disease(GVHD), lymphoproliferative syndrome(PTLD), hematological alterations and death) are analyzed in patients who spleen was included as part of the intestinal graft, in splenectomized patients and those who preservate their native spleen

Results

103 transplants were performed: 26 Intestinal transplantation isolated, 22 liver-small bowel, 52 multivisceral and 3 modified multivisceral. 79% were first grafts, and 21% were retransplantation (27% third graft). Spleen was included as part of the graft in 11.7% patients, their native spleen was preserved in 50.5% and splenectomy was performed in 37.8%. Analyzing comorbidities, humoral rejection was infrequent; and it´s only present in patients with native spleen(4%), presenting positive antibodies without rejection in 17%, compared to 2.5% of splenectomized. Chronic rejection, it's 4 times more frequent in native spleen versus splenectomized(OR:4, CI:2-30). None of the patients with transplanted spleen presented chronic or humoral rejection. Cellular rejection is 2 times more frequent in native spleen instead patients with spleen transplanted(OR:2.2, CI:0.5-10.6) and it's 1.5 times more frequent in splenectomized(OR:1.5, CI:0.3-7.6). GVHD is 6 times more frequent in patients with transplanted spleen than in patients who preserve the spleen(OR:6, CI:2.2-13), followed by splenectomized(OR:2.2, CI:1.5-8.2). PTLD is 1.8 times more frequent in patients who preserve their spleen, compared to splenectomized(OR:1.8, CI:0.6-5.5), followed by patients with spleen transplanted(OR:1.4,CI:0.2-9.9). Haematological alterations are 79% more probably in patients with spleen transplanted (OR:3.8, CI:1-14) and 63% more probably in splenectomized versus those that preserve their native spleen(OR:1.7, CI:0.5-5.8). Death is 87% more probably in patients who include the spleen in the graft, compared to those who preserve their native spleen(OR:6.7, CI:1.8-24), followed by splenectomized in whom death is 87% more probably(OR:5,IC:2-13)

Conclusion

Rejection is more frequent in patients with native spleen. Probably due to the confusional factor that supposes the type of transplant performed like the isolated intestinal transplant, not including the liver graft, and is well known the protective factor that this supposes for rejection

Conclusion

Include spleen as part of the intestinal graft is a risk factor to develop PTLD, hematologic alterations and death. So the inclusion of the spleen as part of the intestinal/multivisceral graft is not recommended

Conclusion

Preserve native spleen is a risk factor to develop GVHD. However, it seems to be a protective factor against the development of other comorbidities, so it's recommended to preserve native spleen whenever is possible

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