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Splenectomy and Death in Renal Transplant Patients

Splenectomy and Death in Renal Transplant Patients Abstract • To determine any association of splenectomy and death, 191 recipients of a single renal transplant were reviewed. Pretransplant splenectomy was performed in 90(47%) patients and the spleen was retained ("spleen-retaining") in 101 (53%). Sixty-eight patients (36%) died. Thirty-two fatal infections occurred in asplenic patients compared with ten infection-caused deaths in those retaining the spleen; 12 asplenic and 14 spleen-retaining patients died of noninfectious causes. Age, sex, graft source, HLA mismatch, and period of graft function were similar in asplenic and spleen-retaining patients who died. Prospective, multicenter, and single-center studies support divergent conclusions regarding the risks and benefits of splenectomy in transplantation. Study of specific center experience should precede adopting a policy of pretransplant splenectomy, an irreversible form of immunosuppression significantly related to fatal infection. (Arch Surg 1983;118:795-799) References 1. Fryd DS, Sutherland ER, Simmons RL, et al: Results of a prospective randomized study on the effect of splenectomy versus no splenectomy in renal transplant patients . Transplant Proc 1981;13:48-56. 2. Stuart FP, Reckard CR, Ketel BL, et al: Effect of splenectomy on first cadaver kidney transplants . Ann Surg 1980;192:553-561.Crossref 3. Advisory Committee to the Renal Transplant Registry: The 13th report of the human renal transplant registry. Transplant Proc 1977;9:9-26. 4. Cerilli J, Jones L: A reappraisal of the role of splenectomy in children receiving renal allografts . Surgery 1977;510-513. 5. McEnery PT, Flanagan J: Fulminant sepsis in splenectomized children with renal allografts . Transplantation 1977;154-155. 6. Opelz G, Terasaki PI: Effect of splenectomy on human renal transplants . Transplantation 1973;15:605-609.Crossref 7. Rai GS, Wilkinson R, Taylor RMR, et al: Adverse effect of splenectomy in renal transplantation . Clin Nephrol 1978;9:194-199. 8. Schroter GPJ, West JC, Weil R: Acute bacteremia in asplenic renal transplant patients . JAMA 1977;237:2207-2208.Crossref 9. Peters TG, Brannen GE, Weil R: Acute rejection episodes and long-term transplant function . Arch Surg 1979;114:574-578.Crossref 10. Starzl TE: Experience in Renal Transplantation . Philadelphia, WB Saunders Co, 1964. 11. Kauffman HM, Lawson RK, Adams MB, et al: Posttransplant hypersplenism . Transplant Proc 1979;11:96-99. 12. Woods JE, DeWeerd JH, Johnson WJ, et al: Splenectomy in renal transplantation: Influence on azathioprine sensitivity . JAMA 1971;218: 1430-1431.Crossref 13. Pollak R, Nishikawa RA, Mozes MF, et al: Azathioprine-induced leukopenia: Clinical significance in renal transplantation . J Surg Res 1980;29:258-264.Crossref 14. Mozes MF, Spigos DS, Jonasson O, et al: Transcatheteric partial splenic embolization (PSE) for azathioprine intolerance in renal transplant recipients . Transplant Proc 1979;11:45-48. 15. Eichner ER: Splenic function: Normal, too much and too little . Am J Med 1979;66:311-320.Crossref 16. Eraklis AJ, Kevy SV, Diamond LK, et al: Hazard of overwhelming infection after splenectomy in childhood . N Engl J Med 1967;276:1225-1228.Crossref 17. O'Neal BJ, McDonald JC: The risk of sepsis in the asplenic adult . Ann Surg 1981;194:775-778.Crossref 18. Linnemann CC, First MR: Risk of pneumococcal infections in renal transplant patients . JAMA 1979;241:2619-2621.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Splenectomy and Death in Renal Transplant Patients

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1983.01390070007002
Publisher site
See Article on Publisher Site

Abstract

Abstract • To determine any association of splenectomy and death, 191 recipients of a single renal transplant were reviewed. Pretransplant splenectomy was performed in 90(47%) patients and the spleen was retained ("spleen-retaining") in 101 (53%). Sixty-eight patients (36%) died. Thirty-two fatal infections occurred in asplenic patients compared with ten infection-caused deaths in those retaining the spleen; 12 asplenic and 14 spleen-retaining patients died of noninfectious causes. Age, sex, graft source, HLA mismatch, and period of graft function were similar in asplenic and spleen-retaining patients who died. Prospective, multicenter, and single-center studies support divergent conclusions regarding the risks and benefits of splenectomy in transplantation. Study of specific center experience should precede adopting a policy of pretransplant splenectomy, an irreversible form of immunosuppression significantly related to fatal infection. (Arch Surg 1983;118:795-799) References 1. Fryd DS, Sutherland ER, Simmons RL, et al: Results of a prospective randomized study on the effect of splenectomy versus no splenectomy in renal transplant patients . Transplant Proc 1981;13:48-56. 2. Stuart FP, Reckard CR, Ketel BL, et al: Effect of splenectomy on first cadaver kidney transplants . Ann Surg 1980;192:553-561.Crossref 3. Advisory Committee to the Renal Transplant Registry: The 13th report of the human renal transplant registry. Transplant Proc 1977;9:9-26. 4. Cerilli J, Jones L: A reappraisal of the role of splenectomy in children receiving renal allografts . Surgery 1977;510-513. 5. McEnery PT, Flanagan J: Fulminant sepsis in splenectomized children with renal allografts . Transplantation 1977;154-155. 6. Opelz G, Terasaki PI: Effect of splenectomy on human renal transplants . Transplantation 1973;15:605-609.Crossref 7. Rai GS, Wilkinson R, Taylor RMR, et al: Adverse effect of splenectomy in renal transplantation . Clin Nephrol 1978;9:194-199. 8. Schroter GPJ, West JC, Weil R: Acute bacteremia in asplenic renal transplant patients . JAMA 1977;237:2207-2208.Crossref 9. Peters TG, Brannen GE, Weil R: Acute rejection episodes and long-term transplant function . Arch Surg 1979;114:574-578.Crossref 10. Starzl TE: Experience in Renal Transplantation . Philadelphia, WB Saunders Co, 1964. 11. Kauffman HM, Lawson RK, Adams MB, et al: Posttransplant hypersplenism . Transplant Proc 1979;11:96-99. 12. Woods JE, DeWeerd JH, Johnson WJ, et al: Splenectomy in renal transplantation: Influence on azathioprine sensitivity . JAMA 1971;218: 1430-1431.Crossref 13. Pollak R, Nishikawa RA, Mozes MF, et al: Azathioprine-induced leukopenia: Clinical significance in renal transplantation . J Surg Res 1980;29:258-264.Crossref 14. Mozes MF, Spigos DS, Jonasson O, et al: Transcatheteric partial splenic embolization (PSE) for azathioprine intolerance in renal transplant recipients . Transplant Proc 1979;11:45-48. 15. Eichner ER: Splenic function: Normal, too much and too little . Am J Med 1979;66:311-320.Crossref 16. Eraklis AJ, Kevy SV, Diamond LK, et al: Hazard of overwhelming infection after splenectomy in childhood . N Engl J Med 1967;276:1225-1228.Crossref 17. O'Neal BJ, McDonald JC: The risk of sepsis in the asplenic adult . Ann Surg 1981;194:775-778.Crossref 18. Linnemann CC, First MR: Risk of pneumococcal infections in renal transplant patients . JAMA 1979;241:2619-2621.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1983

References