Phagocyte function after splenic autotransplantation

This study was designed to examine the role of splenectomy and autotransplantation with regard to the leukocyte/differential cell counts and the function of peripheral blood phagocytes. Eleven groups of 40 Wistar male rats in each group either underwent total splenectomies or sham operations. The splenectomized groups underwent autotransplantations with 10% through 90% of the weight of the intact spleen. The leukocyte count and the oxidative burst response of the blood leukocytes were measured in each group. It was shown that a total splenectomy did not alter the leukocyte/differential cell counts. Furthermore, the blood picture remained basically unchanged after an autotransplantation with 10% through 90% of the weight of the intact spleen. The phagocyte oxidative burst response was measured by chemiluminescence. The chemiluminescence response of these cells was reduced after a total splenectomy. The phagocyte oxidative burst response returned to normal levels following an autotransplantation. There was no correlation between the amount of autotransplanted spleen and the degree of the oxidative burst response. These findings indicated that a splenectomy results in a diminished phagocyte oxidative burst response and that a spleen autotransplantation returns this function to normal levels.     

Experimental study on function of regenerated splenic tissue after splenic autotransplantation

To prevent postsplenectomy overwhelming sepsis, splenic autotransplantation has been clinically attempted. However, function of regenerated splenic tissue after splenic autotransplantation has not been completely understood. Changes in weigh of regenerated splenic tissue, splenic blood flow, splenic immune responses and phagocytic function were studied for one year after splenic autotransplantation using Sprague-Dawley rats. At one year after autotransplantation, the weight of regenerated splenic tissue was increased to 80% of the originally implanted spleen and the blood flow was increased to 80% of the control spleen. The counts of lymphocytes and macrophages in the regenerated splenic tissue were significantly low at eight weeks after transplantation, however lymphocytes was increased to 58.8% and macrophages was increased to 29.5% of the control spleen at 16 weeks after transplantation. The blast formation of splenic lymphocytes was lower at the early stage after transplantation, thereafter, it was increased at the later time after transplantation. Microangiography of the regenerated spleen showed new capillaries around the implanted tissue 2 weeks after transplantation. These results suggested that the transplanted splenic tissue was regenerated to the similar structure to normal spleen and immunological function was recovered close to the normal splenic tissue.     

Splenic phagocytic function after partial splenectomy and splenic autotransplantation

We investigated splenic reticuloendothelial activity after splenic preservation procedures to determine their effect upon the phagocytic function of the spleen. We performed the following procedures in Sprague-Dawley rats: sham laparotomy, total splenectomy, hemisplenectomy, subtotal splenectomy, or total splenectomy with intraperitoneal splenic autotransplantation. At nine weeks after operation, phagocytic function of the spleen was determined by measuring radiocolloid uptake. Mean (+/- SEM) splenic phagocytic indices for sham laparotomy (41.2 +/- 2.9), hemisplenectomy (44 +/- 2.9), and subtotal splenectomy (43.2 +/- 5.2) were similar; however, the phagocytic index was reduced markedly after autotransplantation (15.8 +/- 2.2). These data demonstrate that the phagocytic function of the spleen after hemisplenectomy and subtotal splenectomy correlates highly with the weight of the splenic remnant; however, phagocytic function after autotransplantation remains reduced even after accounting for differences in splenic weight.     

Regeneration and function of autotransplantation of splenic tissue after splenectomy

In traumatic rupture, it is often not possible to repair the spleen. Splenectomy results in increased susceptibility to sepsis with a high mortality rate. Autotransplantation of splenic tissue has been suggested, but its functional value is still in doubt, particularly the ability of autotransplanted spleen to resist intravenous bacterial challenge. The ability to sequestrate denatured^99mTc (technetium-99m) RBC (red blood cells) and to resist intravenous pneumococci was studied in sham-operated (control) rats, splenectomized rats, and splenectomized rats with autotransplanted spleen. Histopathologic tests were also performed. There was a gradual increase in the splenic sequestration of the denatured^99mTc RBC with a spleen-to-blood ratio of 0.19 to 1.5 at 2 and 30 weeks after the splenic reimplantation. Prior to 18 weeks after the splenic autotransplantation, no rat survived the intravenous pneumococcal challenge, but at 28–30 weeks, 80% of the rats survived the challenge indicating an increased splenic activity at this time. There was also a corresponding increase in splenic tissue weight from 241 mg at the time of autotransplantation to 417 mg beginning at the 24th week after the reimplantation. Four to 5 weeks after the transplantation, the spleens had a fairly normal histological architecture. The present study, therefore, indicates that autotransplanted splenic tissue is capable of restoring the ability to resist intravenously injected pneumococcal challenge, to sequestrate denatured^99mTc RBC, and to regenerate normal splenic tissue within 24–30 weeks after the reimplantation.

---

Resumen En caso de ruptura traumática, con frecuencia no es posible reparar el bazo. La esplenectomá resulta en una susceptibilidad aumentada a la sepsis, con elevadas tasas de mortalidad. El autotransplante de tejido esplénico ha sido propuesto, pero su capacidad funcional se halla todavía en duda, particularmente en cuanto a su habilidad para resistir el desafío de una inyección bacteriana intravenosa. La habilidad para secuestrar corpúsculos rojos desnaturalizados y marcados con tecnecio-99m (Tc-99m CR) y de resistir neumococos intravenosos fue estudiada en operaciones fantasmas (Sham) en ratas controles, en ratas esplenectomizadas, y en ratas esplenectomizadas con bazos autotransplantados. Estudios histopatológicos también fueron realizados. Se observó un incremento gradual en el secuestro esplénico de los Tc-99m RC con una relación de bazo a sangre de 0.19 a 1.5 a las 2 y 30 semanas después de la reimplantación esplénica. Con anterioridad a las 18 semanas del autotransplante esplénico, ninguna rata sobrevivió a la inyección intravenosa de neumococos, pero a las 28–30 semanas, 80% de las ratas sobrevivieron este desafío, lo cual es indicativo de una actividad esplénica incrementada hacia esta época. También se produjo un aumento correspondiente del peso del tejido esplénico de 241 mg en el momento del autotransplante a 417 mg comenzando la 24^a semana después de la reimplantación. Cuatro a 5 semanas después del transplante, los bazos exhibían una arquitectura histológica bastante normal. En conclusión, el presente estudio indica que el tejido esplénico autotransplantado es capaz de restaurar la habilidad de resistir el desafío de una inyección intravenosa de neumococos, de secuestrar Tc-99m CR, y de regenerar tejido esplénico normal en el curso de 24–30 semanas después de la reimplantación.

---

Résumé Lors des ruptures traumatiques, il est souvent impossible de suturer la rate. Les conséquences de la splénectomie sont représentées par une augmentation des infections avec un fort taux de mortalité. L'autotransplantation du tissu splénique a été proposé mais sa valeur fonctionnelle est toujours mise en doute en particulier en ce qui concerne l'aptitude de la rate autotransplantée à résister à la sépticémie. Les auteurs étudient l'aptitude à sequestrer les hématies dénaturées marquées aux^99mTc (technetium-99m) globules rouges (RBC) et la résistance contre le pneumocoque par voie intraveineuse chez des rats témoins opérés sans splénectomie, des rats splénectomisés et des rats splénectomisés avec autotransplantation splénique. Des examens histopathologiques sont aussi pratiqués. Il existe une augmentation graduelle dans la séquestration splénique des hématies marquées avec un rapport rate-sang de 0.19 à 1.5 à la deuxième et la trentième semaine après la réimplantation splénique. Aucun rat n'a survécu à l'injection de pneumocoque avant les 18 semaines et après autotransplantation, alors que à partir de la 28-ième à la trentième semaine, 80% des rats ont survécu à l'infection indiquant une augmentation de l'activité splénique à cette période. De même il a été observé une augmentation du poids tissulaire splénique concomittante de 241 mg au moment de l'autotransplantation, à 417 mg à partir de la 24 ème semaine après réimplantation. Quatre à 5 semaines après la transplantation, la rate a pratiquement récupéré une architecture histologique normale. Cette étude indique que le tissu splénique autotransplanté est capable de récupérer sa capacité de résistance contre l'infection par le pneumocoque injecté par voie intraveineuse, de séquestration des hématies dénaturées marquées au^99mTc et enfin de régénération du tissu splénique normal 24 à 30 semaines après la réimplantation.

---

---

Presented at the Société Internationale de Chirurgie in Paris, September 1985.     

Serum antibody responses to pneumococcal vaccine after splenic autotransplantation

Immunization with pneumococcal capsular polysaccharide vaccines is advocated after splenectomy; however, experimental and clinical data suggest an impaired antibody response in splenectomized individuals. This study examined the value of splenic autotransplantation at various sites in augmenting the antibody response to Type III pneumococcal capsular polysaccharide in mice immunized 3 months after operation. Splenectomy resulted in impaired antibody responses compared to sham-operated mice (p less than 0.001) using an enzyme-linked immunosorbent assay. Mice with intraperitoneal splenic autotransplants, but not mice with subcutaneous or intramuscular transplants, had greater antibody responses compared to splenectomized mice (p less than 0.05). Antibody responses were elevated only in mice autotransplanted with 50% or more of the original splenic mass. Since autotransplantation of splenic tissue augments the antibody response to pneumococcal capsular polysaccharides, the combination of splenic autotransplantation and pneumococcal vaccination may confer more protection than either modality alone in individuals who must undergo splenectomy.     

自体脾腹膜后移植在创伤性脾破裂中的临床应用

目的探讨自体脾组织移植在治疗创伤性脾破裂的应用.方法对本组于2000年1月至2005年4月22例脾破裂行全脾切除后,再行自体脾组织腹膜后移植术.通过检测外周血IgM、IgA、IgG水平和B超,CT、99mTc扫描来观察移植脾片成活和吞噬功能恢复情况.结果术后随访均显示移植脾存活良好,脾功能满意.结论自体脾组织移植可作为严重脾外伤全脾切除术后保留脾功能的一个重要有效手段.     

脾损伤自体脾组织移植的临床应用

目的：探讨自体脾组织移植在临床中的应用。方法：总结32例脾外伤行全脾切除自体脾组织移植手术，其中采用大网膜囊内移植18例，去粘膜游离空肠段内移植12例，腹直肌鞘内移植2例。结果：术后随访均显示脾功能满意，尤以去粘膜游离空肠段内移植效果最好。结论：自体脾组织移植可作为严重脾外伤、全脾切除术后保留脾功能的一个重要有效手段，移植脾的功能恢复与血供有密切的关系。     

Human islet autotransplantation to prevent diabetes after pancreas resection

In severe cases of chronic pancreatitis pain relief can often only be achieved by pancreas resection, however this may render the patient diabetic. In an effort to prevent diabetes some patients may be suitable for a simultaneous islet autotransplant. The last report from the International Islet Transplant Registry has reported 222 cases. This review discusses the current progress in human islet autotransplantation.     

Feasibility of correction of insulin insufficiency after autotransplantation of splenic tissue in duodenopancreatectomy

Autotransplantation of splenic tissue in two patients after total duodenopancreatectomy and splenectomy for trauma of the duodenum and pancreas has demonstrated positive results and stable compensation of insulin insufficiency in two cases. Experimental studies of autotransplantation of splenic tissue carried out on 20 cats and 100 rats with pancreatectomy- and alloxan-induced diabetes demonstrated good results too. This method may be regarded as the variant of repair therapy with stromal stem-cells of the spleen.     

Intraportal splenic autotransplantation in rats: Feasibility and effectiveness

This experiment was designed to see whether or not normal host resistance to infection could be reestablished in splenectomized animals by intraportal autotransplantation of homogenized splenic tissue. Part I studied the feasibility of the technique. Within 1 hr of splenectomy, 16 adult Lewis rats received an intraportal injection of autogenous splenic tissue which had been passed through a 500-μm screen. Five rats died acutely from hemorrhage at the site of injection. The others tolerated the infusion well, both acutely and chronically. The animals developed only transient elevations in liver enzymes; chronic portal hypertension did not occur. Histologically, splenic tissue could be demonstrated within terminal portal venules. Part II assessed the effectiveness of intraportal splenic autotransplantation. Eight to twelve months after splenectomy, autotransplantation, or sham operation, 103 Sprague-Dawley rats were challenged with intravenous boluses of 10⁵ to 10⁸ pneumococci. Mortality was 91% for splenectomized animals, 88% for animals bearing autotransplants, and 59% for controls. Thus intraportal splenic autotransplantation is technically feasible in rats. The grafts are well tolerated by the liver, and splenic tissue is preserved in intimate contact with the blood stream. Even after 8 to 12 months, however, such autografts are not capable of providing normal protection against massive pneumococcemia.     

The risks of total pancreatectomy and splenic islet autotransplantation

The intraportal site is the most common site for islet transplantation. Many other sites have been tried experimentally, including the spleen, which has successfully lead to insulin independence in a number of animal models. Nevertheless, there are no detailed reports of total pancreatectomy and splenic islet autotransplantation in humans. Five patients underwent total pancreatectomy and splenic islet autotransplantation for chronic pancreatitis. Four patients had a pylorus-preserving total pancreatectomy and one patient a duodenal-preserving pancreatectomy. In three cases islets were embolized into both the portal vein and spleen. Two patients received splenic islet transplants alone. Islets were transplanted by retrograde venous infusion via the short gastric veins (n = 3), splenic vein stump (n = 1), and the left gastroepiploic vein (n = 1). The total volumes of transplanted pancreatic digest in those receiving combined intraportal and splenic autografts (n = 3) were 15.8, 13.0, and 13.5 ml. The volumes in those receiving a splenic-alone autograft (n = 2) were 12.0 and 5 ml. The mean rise in portal pressure was 18 cm of water. Complications related to the splenic autograft included a wedge splenic infarct, an emergency splenectomy, and a portal vein thrombosis in one patient having a combined intraportal and splenic autograft. Two patients developed insulin independence. two patients were still insulin independent at 1-year follow-up, and all had normal HbA1c levels (mean 5.6, range 5.2-6.3). Splenic islet autotransplantation, after total pancreatectomy, does lead to insulin independence. However, in our experience the combined procedure has a high morbidity because of splenic infarction and venous thrombosis.     

Late splenic metastasis after curative resection for oesophageal carcinoma

The spleen is an unusual site of distant metastasis from solid tumours. While contiguous involvement of the spleen may occur in tumours arising from the stomach, pancreas or colon; the spleen as the seat of distant metastasis is a rare occurrence. We report herewith one such instance of metastatic involvement of the spleen in an operated case of carcinoma oesophagus.     

Optimal site and amount of splenic tissue for autotransplantation.

Clinical and basic studies have documented a high susceptibility to pneumococcal infection in asplenic humans and animals. It has been suggested that autotransplantation of splenic tissue might be a method of providing host resistance when total splenectomy is necessary. However, the effect of splenic autograft has remained controversial. This study was performed to evaluate the most effective site and amount of splenic autograft using rats. Rats were divided into five groups for the purpose of determining the site of splenic autotransplantation: splenectomy, sham operation, implantation into the omental pouch, intraperitoneal implantation, and intramuscular implantation. For determining the amount for autotransplantation, the rats were divided into seven groups: splenectomy, sham operation, and implantations of 25, 50, 100, 200, or 300 mg of splenic tissue. All animals were challenged with Streptococcus pneumoniae type 6, 16 weeks after surgery. Howell-Jolly bodies appeared postsplenectomy, but disappeared in the implanted rats 16 weeks after the operation. Histologically, the implanted tissue was indistinguishable from that of a normal spleen. Pneumococcal clearance from the bloodstream and survival rate were significantly higher in rats implanted in the omental pouch as compared with splenectomized rats. Intraperitoneal and intramuscular implanted rats did not show a significant difference from the splenectomized rats. More than 50% of splenic tissue for autograft showed a significant increase in pneumococcal clearance and survival rate as compared with that of splenectomized rats. It was suggested that the most effective site of autotransplantation is the omental pouch and approximately 50% of the whole spleen would be necessary for prevention from sepsis.     

Exogenous and endogenous angiogenic stimuli do not augment splenic autotransplantation.

OBJECTIVE: To find out if angiogenic stimulation improves the ability of the spleen to regenerate. DESIGN: Experimental study. SETTING: Teaching hospital, Republic of Ireland. ANIMALS: 27 male Sprague-Dawley rats. INTERVENTIONS: Each spleen was removed and half was reimplanted in the greater omentum. The rats were randomised into three groups of 9 each: the first (control) group was given no stimulation; the second had the implanted spleen sutured into the omentum with 6/0 polypropylene; and in the third group the implanted spleen was injected with human recombinant vascular endothelial growth factor (VEGF) 500 microg. MAIN OUTCOME MEASURES: Clearance of Howell-Jolly bodies, and the weight and histological appearance of the splenic remnant at 3 months. RESULTS: The splenic remnant was significantly larger at 3 months in the control group (p = 0.0006). Histological examination of the tissue from the control group showed that it was architecturally similar to that of normal functioning spleen, whereas the tissue from the two treated groups contained less lymphoid tissue and showed widespread acute and chronic inflammatory changes. There was a significantly greater clearance of Howell-Jolly bodies (an index of splenic function) from the peripheral blood of the control group (p = 0.0009). CONCLUSION: The excellent recovery of the splenic remnant in the control group suggests that the procedure of splenic autotransplantation might warrant further consideration and study.