Role of Splenectomy in Human Liver Transplantation Under Modern-Day Immunosuppression
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Between January 1987 and October 1991, 1466patients underwent consecutive Orthotopic LiverTransplantation (OLTx) at the University of Pittsburgh.Forty of these patient's had concomitant splenectomywith OLTx. These patients were compared to 147randomly selected OLTx patients without splenectomywithin the same time period. One-year patient and graftsurvival (PS and GS) were lower in splenectomized (Splx) patients compared to nonsplenectomized(non-Splx) patients (59% vs 86% PS, 55% vs 80% GS,respectively). One-month and one-year patient mortalityin the Splx group was higher than in the non-splxpatients (20% vs 3.4%, P < 0.001 for one month; 40%vs 14.3%, P = 0.003 for one year, respectively).One-month and one-year sepsis-related mortality was alsohigh in Splx patients (17.5% vs 2.7%, P = 0.0022, for one month, and 30% vs 11.5%, P = 0.0043,for one year, respectively). We conclude thatconcomitant splenectomy with OLTx has a significantlyhigher patient mortality mainly due to its septiccomplications and, at present, unless there is a specificindication for a splenectomy, the routine addition ofthis procedure to liver allograft surgery would not berecommended.
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