Spleen transplantation

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Spleen transplantation
ICD-9-CM 41.94

Spleen transplantation is the transfer of spleen or its fragments from one individual to another. It is under research for induction of immunological tolerance for other transplanted organs. Success has been achieved in rodent models. Recently, evidence has been obtained for a tolerogenic effect of a spleen transplant in miniature swine.[ citation needed ] Also, the spleen harbors primitive hematopoietic progenitor cells. Spleen transplantation has been performed on humans with mixed results. [1] [2]

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Autotransplantation

Splenic tissue can be deliberately autotransplanted after splenectomy, as some tissue will still be viable, to attempt to preserve some splenic function (with the goal of preventing OPSI). Usually this involves leaving parts of splenic parenchyma in pouches of omentum. This is not without risk or complication. This was performed after splenosis was understood; splenosis is the spontaneous reimplantation of splenic tissue elsewhere in the body (usually the abdomen) after it has broken off from the spleen due to trauma or surgery. [3]

According to a 2020 review of 18 experimental studies, the transplanted spleen appears functional, with 95% of re-implanted tissue undergoing regeneration (by scintigraphy) and 90% of patients having a normalized blood film (suggesting functional blood filtration). All studies also report restoration of antibody levels. There is insufficient evidence to draw conclusions about OPSI rates. Of patients, 3.7% suffer from complications. [3]

See also

Related Research Articles

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<span class="mw-page-title-main">Splenectomy</span> Surgical removal of the spleen

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<span class="mw-page-title-main">Graft-versus-host disease</span> Medical condition

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<span class="mw-page-title-main">Splenomegaly</span> Medical condition

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<span class="mw-page-title-main">Splenic infarction</span> Medical condition

Splenic infarction is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction in the organ. Splenic infarction occurs when the splenic artery or one of its branches are occluded, for example by a blood clot.

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<span class="mw-page-title-main">Blunt splenic trauma</span>

Blunt splenic trauma occurs when a significant impact to the spleen from some outside source damages or ruptures the spleen. Treatment varies depending on severity, but often consists of embolism or splenectomy.

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<span class="mw-page-title-main">Haematopoietic system</span>

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<span class="mw-page-title-main">Intestine transplantation</span> Surgical replacement of the small intestine

Intestine transplantation is the surgical replacement of the small intestine for chronic and acute cases of intestinal failure. While intestinal failure can oftentimes be treated with alternative therapies such as parenteral nutrition (PN), complications such as PN-associated liver disease and short bowel syndrome may make transplantation the only viable option. One of the rarest type of organ transplantation performed, intestine transplantation is becoming increasingly prevalent as a therapeutic option due to improvements in immunosuppressive regimens, surgical technique, PN, and the clinical management of pre and post-transplant patients.

Splenosis is the result of spleen tissue breaking off the main organ and implanting at another site inside the body. This is called heterotopic autotransplantation of the spleen. It most commonly occurs as a result of traumatic splenic rupture or abdominal surgery. Depending on the location of the spleen, the new piece usually implants in another part of the abdominal cavity. Single case reports also describe splenosis in the thoracic cavity, in subcutaneous tissue, in the liver or in the cranial cavity. Splenosis must be distinguished from the presence of additional spleens, which are innate and are the result of differences in embryological development. Additionally, splenosis must be differentiated from malignant tumors which may look similar when imaged.

References

  1. Wu; et al. (January 2011). "Graft-versus-host disease after intestinal and multivisceral transplantation". Transplantation. 91 (2): 219–224. doi: 10.1097/tp.0b013e3181ff86ec . PMID   21076376. S2CID   35828611.
  2. Deierhoi; et al. (April 1986). "Lethal graft-versus-host disease in a recipient of a pancreas-spleen transplant". Transplantation. 41 (4): 544–546. doi: 10.1097/00007890-198604000-00028 . PMID   3515658.
  3. 1 2 Surendran, A; Smith, M; Houli, N; Usatoff, V; Spelman, D; Choi, J (April 2020). "Splenic autotransplantation: a systematic review". ANZ Journal of Surgery. 90 (4): 460–466. doi:10.1111/ans.15383. hdl: 11343/286471 . PMID   31576640. S2CID   203639290.