Should splenic autotransplantation be considered after total splenectomy due to trauma?

ABSTRACT Trauma is a public health problem and the most common cause of death in people under the age of 45. In blunt abdominal trauma, the spleen is the most commonly injured organ. Splenectomy remains the most common treatment, especially in high-grade lesions, despite increased nonoperative treatment. Removal of the spleen leads to increased susceptibility to infections due to its role in the immune function. Postsplenectomy sepsis is an important complication and presents a high mortality rate. Patients undergoing splenectomy should be immunized for encapsulated germs, as these are the agents most commonly associated with such infections. Splenic autotransplantation is a simple procedure, which can be an alternative to reduce infection rates consequent to total splenectomy, and reduce costs related to hospitalizations. This review aims to provide evidence-based information on splenic autotransplantation and its impact on the prognosis of patients undergoing total splenectomy. We searched the Cochrane Library, Medline/PubMed, SciELO and Embase, from January 2017 to January 2018 and selected articles in English and Portuguese, dated from 1919 to 2017. We found that the adjusted risk of death in splenectomized patients is greater than that of the general population, and when total splenectomy is performed, splenic autotransplantation is the only method capable of preserving splenic function, avoiding infections, especially postsplenectomy sepsis. Health professionals should be familiar with the consequences of the method chosen to manage the patient suffering from splenic trauma.

Histological aspects of autologous transplantation of different fragments of the spleen in rats

PURPOSE: To evaluate macro and microscopically the evolution of autotransplants of fragments of spleen different fragments in the greater omentum, after eight weeks of observation. METHODS: Twenty rats Wistar were used, males and adults, submitted to total splenectomy and divided in two groups. The group I - ten animals with implant of spleen fragment (25% weight of spleen) in the omentum; and group II - ten animals with implant of spleen fragment (30% weight of spleen) in the omentum. It was analyzed macro and microscopically the evolution of the implant. RESULTS: It was observed adherences to the adjacent tissues and vascularization in all of the fragments transplanted. The group I and II presented white pulp with follicular formations and lymphoid tissue preserved, and the red pulp in cordon aspect. The group II presented white pulp more disorganized and red pulp hemorrhagic. The active macrophages were observed in the group I and II. CONCLUSION: The splenic autotransplantation of the group I showed better regeneration.