Hemorheological follow-up after splenectomy and spleen autotransplantation in mice

We previously reported on a spleen autotransplantation model in mice, with spleen function studies at 6 weeks. The present study was undertaken to investigate long-term hemorheological functions. A/J and BALB/c inbred mice were divided into four groups: control, sham surgery (SH), splenectomy (SE), and spleen autotransplantation (AU). Hematological and hemorheological parameters were determined. Leukocyte counts in the SE and AU groups were significantly higher than in controls, while hematocrit levels were markedly lower. Mean erythrocyte volume did not change significantly. Platelet counts in the AU group were significantly lower, and red blood cell deformability was significantly worse in the SE group. The AU group also had increased cell transit time, but it was less than that in the SE group. The SE group showed the highest fibrinogen levels. We conclude that there are some consistent differences in hematological parameters between splenectomy and spleen autotransplantation. These data suggest that spleen autotransplantation may partially restore hemorheological functions following splenectomy.     

Comparative hematologic and immunologic studies of patients with splenectomy and spleen autotransplantation

We compared changes in haematological and immunological parameters of patients with splenectomy (n=24), splenectomy plus spleen autotransplantation (n=12) and healthy controls (n=23). In the autotransplantation group pieces of the removed spleen were placed into the omentum with good visible circulation. Significant alterations in the hematological status and in some immunological parameters were observed in both groups of patients who were operated on compared to those in the control group. There was no difference, however, between the results of the two groups of operated patients. Therefore, we emphasize the importance of vaccination in patients with spleen autotransplantation in order to prevent potential sepsis. In addition, we recommend the possible further use of spleen autotransplantation.     

Comparative investigation of the hematologic and immunologic effects of splenectomy and spleen autotransplantation in mice

We have analysed the hematological and immunological effects of the Furka's spleen chip method of autotransplantation in Balb/c mice two and eight months after splenectomy and autotransplantation. Our results showed that the autotransplants had positive effect on the partial restoration of the damaged elements of both cellular and humoral immunity appearing after splenectomy. However, these beneficial effects may have some dependence of time and species.     

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.     

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.     

Cellular and serological changes in the peripheral blood of splenectomized and spleen autotransplanted mice

BACKGROUND: Our department worked out a modified surgical form of spleen autotransplantation earlier, named "spleen apron method" introduced already into the clinical practice. Recently we tested the immunological changes in a group of patients autotransplanted with about 10-15% of their spleen, what was the at least always implantable amount after the severe splenic injuries. In the current work we aimed at measuring some cellular and serological changes in the peripheral blood of splenectomized and spleen autotransplanted inbred mice two and eight months after the operations in order to get more unambiguous results than that we could obtain in our patients with this technique. MATERIALS AND METHODS: We divided 96 two months old Balb/c female mice into eight groups (n = 12/group). The group of controls, sham operated, splenectomized and autotransplanted animals with two and eight months of survival time after the operations. During the autotransplantation we inserted the same amount of spleen, five slices, "chips," about 10-15% of total mass of spleen, into the greater omentum similarly as it was used in the patients. The concentration of serum proteins were measured by laser nephelometry. The lymphocyte subsets were analyzed by flow cytometry. RESULTS: We found that two months after the operations the number of CD 19+ B-cells increased in the splenectomized but decreased in the autotransplanted animals. Eight months after the operations the number of both CD3+ T and CD19+ B lymphocytes decreased both in the splenectomized and autotransplanted animals compared to the controls and sham operated mice. However, the numbers of T and B cells were slightly but not significantly higher in the autotransplanted than in the splenectomized mice. The serum level of IgM was also decreased in the splenectomized and autotransplanted mice at both time points, however, eight months after the operations the concentration of IgM was significantly higher in the autotransplanted group than in the splenectomized animals. CONCLUSION: The effects of autotransplanted "chips" were different at the various ages of the animals. Additionally, they showed some immunological benefit being quantitatively in accordance to the amount of the transplanted spleen. The elevated level of serum IgM what we found in the autotransplanted mice even with this amount of transplanted spleen eight months after the operations, however, might have the potentially greatest importance compared to splenectomy. These experiments can prove that the attempts for autotransplantation may have real perspectives but their efficacy depends on the amount of the successfully transplanted (saved) mass of spleen.     

自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症

目的 探讨腹膜后自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症的临床疗效.方法 将2003年1月至2006年12月收治的36例肝硬化门静脉高压症患者随机分为自体脾移植组(n=18)和脾切除组(n=18),自体脾移植组接受脾切除、食管横断吻合及自体脾移植术,脾切除组接受脾切除、食管横断吻合术.于术前及术后2～6个月定期观察两组患者的一般情况、行脾脏放射性核素扫描,同时检测肝功能、血清促吞噬素(Tuftsin)及IgM水平,并行组间及手术前后比较分析.结果 自体脾移植组患者术后2个月血清Tuftsin和IgM水平与术前比较无明显差异(P0.05),而脾切除组患者术后2个月血清Tuftsin和IgM水平较术前明显降低(P<0.05);自体脾移植术对患者肝功能无明显影响;术后2个月放射性核素扫描证实移植脾于腹膜后存活.结论 自体脾移植对保留机体脾脏免疫功能具有重要价值,腹膜后自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症的临床效果确切,值得推广应用.     

Splenic Autotransplantation for a Congested and Enlarged Wandering Spleen with Torsion: Report of a Case

In children with diseases of the spleen, every effort should be made to preserve the organ, to prevent severe infections postsplenectomy. We report the case of a 7-year-old girl with torsion of a wandering spleen who we treated by autotransplantation of splenic tissues following splenectomy, when fixation of the enlarged spleen seemed impossible. Spleen scintigraphy showed uptake in the regenerating splenic tissues 9 months after surgery, and evidence of an increase in the size of the tissues 23 months after surgery. Howell–Jolly bodies had disappeared by 16 months after surgery. These findings suggested that the transplanted splenic tissues were resuming splenic functions. Based on our experience with this case, we conclude that autotransplantation after splenectomy is a treatment option for wandering spleen with torsion when fixation seems difficult because of splenic congestion and enlargement.     

Early clinical experience with postoperative monitoring of a patient after laparoscopic splenectomy combined with spleen autotransplantation. A case report

We performed splenectomy combined with spleen autotransplantation after blunt abdominal trauma by minimally invasive technique at the County Teaching Hospital in Kecskemét. In case of advanced post traumatic spleen injury, spleen autotransplantation (Furka's spleen chips) is a well-known method to try to avoid postsplenectomy syndrome. During the operation, when in situ preservation of the spleen is not possible, chips of spleen tissue are transplanted into the omentum. Function of the transplanted spleen tissue was monitored by scintigraphy. We describe two different types of spleen scintigraphy to check the viability of spleen chips.     

Autologous transplantation of splenic tissue after splenectomy in gunshot abdominal wounds

Results of experimental (12) and clinical (26) observations of autotransplantation of spleen fragments into the greater omentum after splenectomy are described. Optimum sizes of the transplanted fragments of the spleen were determined. The influence of this operation on homeostasis was studied. Terms of the taking of spleen fragments were established by morphological and radionuclide methods.     

Splenic tissue autotransplantation in rabbits: no restoration of host defense

BACKGROUND: The loss of spleen may increase the incidence of overwhelming sepsis. To prevent this, splenic autotransplantation has been performed in humans and experimental animals. However, there is still controversy about the effectiveness of regenerated splenic tissue in preventing infection. This study explored the effectiveness of splenic tissue autotransplantation in restoring host defense. MATERIALS AND METHODS: Rabbits were divided into three groups: splenic autotransplantation, sham operation, and total splenectomy. Histomorphology, T-lymphocyte count, serum lysozyme levels, hemolysin titers, and pneumococcal clearance were observed as read-out parameters over 24 weeks. RESULTS: Histological study showed that the white pulp was poorly developed and central arterioles were missing in the regenerated splenic tissue of the autotransplanted rabbits. The weight of regenerated spleens recovered 6 months later in the splenic autotransplantation group was 11% of that in the sham operation group and was significantly less than the weight at implantation. There was no significant difference in the number of T lymphocytes or level of serum lysozyme between the three groups. A poor antibody response by the rabbits in the splenic autotransplantation and total splenectomy groups was noted after the primary intravenous administration of sheep red blood cells compared to those of sham operation group. After the challenge with type 3 pneumococci intravenously, pneumococcal clearance from the bloodstream in the splenic autotransplantation group did not differ significantly from that in the total splenectomy group, but was markedly delayed compared with that in the sham operation group. CONCLUSIONS: The low quantity and poor quality of the regenerated splenic tissue contribute to the inferior immunoprotective ability of animals autotransplanted with one-third of the original spleen. This suggests that the regenerated spleen cannot compensate for the immunological function of the original one, especially host resistance to infection.     

自体脾移植联合食管下段横断术治疗肝硬化门静脉高压症的临床随机对照观察

目的　采用随机对照研究的方法观察用自体脾移植联合食管下段横断术治疗肝硬化门脉高压症的临床效果。方法　将肝功能ChildA、B级的肝硬化门脉高压症患者随机分为自体脾移植组和切脾组 ,脾移植组采用自体带蒂脾组织腹膜后移植联合改良的食管下段横断术 ,切脾组则采用脾切除联合改良的食管下段横断术 ;以患者术前的情况为对照 ,在术后 2～ 8个月观察患者的一般情况、脾扫描、肝功能、血清Tuftsin、IgM水平。结果　术后第六天切脾组死亡 1例 ,脾移植组出现再出血 1例 ;两组血清Tuftsin、IgM水平有显著性差异 (P <0 .0 5 ) ,在对肝功能的影响上无明显差异。结论　脾自体移植后能够长期存活 ,并能够维持脾脏的基本免疫功能 ,是可以在临床上推广应用的。     

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.     

自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症

目的 本研究比较自体脾移植联合食管横断吻合术与脾切除联合食管横断吻合术治疗门静脉高压症(PHT)的疗效.方法 将30例研究对象平均分为两组.研究组行脾次全切除加自体脾腹膜后移植及食管横断吻合术;对照组行脾切除加食管横断吻合术.于术前1周及术后6个月通过三维动态增强磁共振血管成像(3D DCE MRA)检测其门静脉主干(MPV)管腔横截面积、血流量、血流速度等门静脉系统血流动力学参数及食管胃底曲张静脉的变化,并观察自体移植脾在腹膜后的侧支血管形成与血流方向的改变.并同步检查血清肝纤维化指标及肝功能的重要指标. 结果术后两组MPV的管腔横截面积、MPV的平均流速和MPV的平均流量均比术前明显减小(P＜0.05).且术后研究组MPV的平均流速和平均流量均少于对照组(P＜0.05).两组手术后胃底曲张静脉、食管曲张静脉均消失或明显改善;两组手术前后肝功能的重要指标均差异无统计学意义(P＞0.05).研究组血清透明质酸水平在术后显著下降(P＜0.05),研究组移植脾成活良好,并建立了广泛的侧支循环. 结论自体脾移植联合食管横断吻合术是一种优于脾切除加断流术治疗肝硬化PHT的方法,且未对肝功能造成负面影响.     

Spleen autotransplantation. Morphological and functional follow-up after spleen autotransplantation in mice: a research summary

In 1986, we started the research on spleen surgery aimed at saving the splenic mass after its traumatic injury, with elaboration of special resection and autotransplantation techniques. The researches started on mongrel dogs and were continued on inbred mice and beagle dogs with complex histological, imaging, and laboratory investigations, following-up the function and the regeneration of autotransplanted spleen chips. Performing research on mice provided more immunological methods, such as lymphocyte subsets, immunoglobulin levels, and monitoring the phagocytic functions. Researches showed evidence also on the presence of apoptosis, furthermore, stem cell studies on regeneration and functional restoration of the spleen chips are in progress. Our results contributed to two multidisciplinary guidelines in Hungary: (1) One of them is under preparation and underlines the importance of spleen saving methods after traumatic splenic injury; (2) The second guideline shows that hemorheological changes can be early indicators of the increased sensitivity to postsplenectomy infections.     

Immunological effect of splenectomy in tumor-bearing rat

Immunologic merit and demerit of splenectomy were studied, using experimental model in rat. Animals: SD rat. Tumor: Metastasizing Rat's Mammary Tumor No. 1 (MRMT-1) originally induced by 3-MC administration to SD rat. Experimental study: Splenectomy was done on day before and after subcutaneous inoculation of 200mg of MRMT-1 at the back of 4 week-old female SD rats. Tumor growth following splenectomy and immunological competency of rat's peripheral lymphocytes, spleen cells and thymus cells was investigated and following results were obtained. When splenectomy was done pre-operatively or on the 2nd or 14th day after tumor inoculation, subsequent tumor growth was inhibited, however, when it was done on the 7th day after the inoculation, tumor enhancement and shortening of survival period were observed. When it was done on the 21st day, tumor growth was almost the same as in the rats without splenectomy. The results of cpm values and SI ratio of PHA-induced blastogenesis, and NK-activity indicated that immunological competency of spleen cells of tumor bearers was reduced during the early tumor-bearing period and the late tumor bearing period, while it was increased in the middle tumor bearing period. Tumor growth following splenectomy was considered to be controlled by immunological competency of spleen cells. Thus, it may not be unreasonable that tumor growth is inhibited on some occasions and it is facilitated on other occasions after splenectomy.     

Splenic autotransplantation: determination of the optimum amount required for maximum survival

Splenic salvage in cases of traumatic or iatrogenic injuries may require autotransplantation of splenic fragments when splenorrhaphy or partial splenectomy is not possible. There are no studies which address the issue concerning the optimal amount of spleen to be transplanted in order to yield maximal survival in a model of pneumococcal sepsis. This study uses a Sprague-Dawley rat model to attempt to clarify this issue. Animals were divided into seven groups: control, total splenectomy, 25, 40, 60, 80, and 100% omental pouch autotransplantation. These animals were challenged with intravenous Streptococcus pneumonia Type I after 24 weeks, and mortality and blood culture results were monitored. Transplants were recovered and weights were compared with the weights originally transplanted. Survival and blood culture results were seen to improve in a linear quantitative fashion as the amount of spleen autotransplanted increased up to 80%, after which no further improvement was seen. This data supports the autotransplantation of 80% of the spleen in the Sprague-Dawley rat as the optimum amount to achieve maximal survival in a model of pneumococcal sepsis.     

Can the injured spleen be preserved? Results of 20-year experiments

Researches of different spleen salvaging techniques have begun in 1986 at our department. The early purpose was to develop new spleen preservation surgical techniques, such as spleen autotransplantation and spleen resection. Besides the morphological and radiological examinations we also performed different investigations including hemorheological, hemostaseological and immunological follow-up of the splenic function. From these parameters changes in red blood cell deformability and peripheral phagocyte activity could indicate the possible complications originated from the reduced splenic function. Recent paper takes a survey of these experiences.     

Splenic Autotransplantation Is Always Valid after Splenectomy

When splenectomy is performed, autotransplantation is the only method to preserve splenic function. The most frequently used technique for splenic autotransplantation in humans is the implantation of multiple sections of the splenic parenchyma into pouches created in the greater omentum. However, this technique of autotransplantation is associated with complications. For this reason, a technique in which only one 35-g slice of spleen is transplanted into the greater omentum but positioned within the native hypochondrium can be considered safe and useful for patients. Experimental studies continue to add valuable information to the ongoing research in the field of autotransplantation, providing a baseline for future studies in humans and adding arguments in favor of autotransplantation when the spleen cannot be preserved.     

Relative merits of partial splenectomy, splenic reimplantation, and immunization in preventing postsplenectomy infection.

Partial splenectomy, splenic autotransplantation, and immunization with pneumococcal vaccine have been reported to protect patients against overwhelming postsplenectomy infection, and this study was undertaken to evaluate these therapeutic alternatives. For this purpose 136 rats were divided into experimental groups: 34 controls, 34 splenectomy, 34 partial splenectomy, and 34 splenic autotransplantation animals. Five weeks after operation, two-thirds of the animals were immunized with killed pneumococci. The effects of operation and immunization were studied by challenging the animals intravenously with pneumococci. Pneumococcal antibody titers were determined, and phagocytic uptake of pneumococci by the spleen and liver was measured. Immunization impressively increased the survival rate in all groups. At low-challenge doses autotransplantation prolonged survival. At higher-challenge doses only partial splenectomy increased survival. Partial splenectomy and control animals had higher antibody titers than did splenectomy and autotransplantation rats. Animals with the highest antibody titers had the greatest splenic and hepatic phagocytic uptake of pneumococci. Partial splenectomy was more efficient in removing pneumococci than was autotransplantation. Thus immunization is one of the most important factors contributing to survival after splenectomy. Partial splenectomy is preferable to splenic autotransplantation because it is associated with higher antibody titers after immunization, better pneumococcal splenic uptake, and improved survival rates.