Kato T, Kleiner G, David A, Selvaggi G, Nishida S, Madariaga J, Thompson J, Ruiz P, Tzakis A
Divisions of Transplant, Pediatric Gastroenterology, Pediatric Critical Care Medicine, and Immunopathology, University of Miami, School of Medicine, 1801 NW 9th Avenue, Miami, FL 33136, USA.
Transplant Proc. 2006 Jul-Aug;38(6):1709-10. doi: 10.1016/j.transproceed.2006.05.059.
Inclusion of the donor spleen may be beneficial for small children who receive multivisceral transplantation (MVT) because asplenia is associated with increased risk of bacterial sepsis. Beginning in 2003, the spleen was transplanted together with multivisceral transplantation in 17 children under daclizumab induction (spleen group). The results were compared to 23 children who received multivisceral transplantation without the spleen (control group) with the same immunosuppression regimen. Median age of 17 patients who received a spleen was 0.80 years (range 0.54-1.66). Platelet counts at 30 and 60 days posttransplant were significantly lower in the spleen group (average values: day 30: 399,000 vs 636,000, P = .015; day 60: 413,000 vs 622,000, P = .0056). WBC counts at 30 and 60 days posttransplant were also decreased in the spleen group but the difference was not statistically significant. Median rejection-free survival was 205 days in the spleen group and 101 days in the control group (P = NS). Median length of hospital stay was 39 days in the spleen group and 61 days in the control group. With a median follow-up of 398 days (spleen group) and 1232 days (control group), 3 of 17 (17%) in the spleen group developed graft versus host disease (GVHD), whereas 1 of 23 (4.5%) in control group did (P = NS). In one patient in each group, GVHD was fatal. No patient developed posttransplant lymphoproliferative disorder (PTLD) in the spleen group, whereas 4 of 23 (17%) in the control group developed PTLD. One-year patient survival was 84% in the spleen group and 86% in the control group. Recipients of the spleen as part of a multivisceral graft had significantly lower platelet counts. Rejection-free survival may be prolonged, but the risk of GVHD may be increased.
对于接受多脏器移植（MVT）的幼儿，植入供体脾脏可能有益，因为无脾状态与细菌性败血症风险增加相关。从2003年开始，在17例接受达利珠单抗诱导治疗的儿童中，将脾脏与多脏器移植同时进行（脾脏组）。将结果与23例接受相同免疫抑制方案但未植入脾脏的多脏器移植儿童（对照组）进行比较。接受脾脏移植的17例患者的中位年龄为0.80岁（范围0.54 - 1.66岁）。脾脏组移植后30天和60天的血小板计数显著低于对照组（平均值：第30天：399,000对636,000，P = 0.015；第60天：413,000对622,000，P = 0.0056）。脾脏组移植后30天和60天的白细胞计数也有所下降，但差异无统计学意义。脾脏组的无排斥生存期中位数为205天，对照组为101天（P = 无显著性差异）。脾脏组的住院时间中位数为39天，对照组为61天。脾脏组中位随访398天，对照组中位随访1232天，脾脏组17例中有3例（17%）发生移植物抗宿主病（GVHD），而对照组23例中有1例（4.5%）发生（P = 无显著性差异）。每组各有1例患者的GVHD是致命的。脾脏组无患者发生移植后淋巴细胞增殖性疾病（PTLD），而对照组23例中有4例（17%）发生PTLD。脾脏组的1年患者生存率为84%，对照组为86%。作为多脏器移植物一部分接受脾脏移植的受者血小板计数显著降低。无排斥生存期可能延长，但GVHD风险可能增加。
