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Partial splenectomy before a hematopoietic stem cell transplantation in children.

Publication ,  Journal Article
Hall, JG; Kurtzberg, J; Szabolcs, P; Skinner, MA; Rice, HE
Published in: J Pediatr Surg
January 2005

UNLABELLED: Hematopoietic stem cell (HSC) engraftment is delayed in children with hypersplenism, and splenectomy may improve HSC engraftment. However, the use of total splenectomy in children is limited because of concerns for postsplenectomy sepsis. In this study, the authors sought to assess the role of partial splenectomy for children with hypersplenism undergoing HSC transplantation. METHODS: Five children with a variety of conditions and associated hypersplenism underwent partial splenectomy before an HSC transplantation at the authors' institution between 2000 and 2003. Primary outcome measures were rates of neutrophil and platelet engraftment. Secondary outcome measures included perioperative complications, splenic regrowth, graft-versus-host disease, and infection rate. All outcomes were compared with recipients of an HSC transplant from both age-matched nonsplenectomized children (n = 497) and hypersplenic children who underwent total splenectomy (n = 10). Outcomes were compared using Wilcoxon's rank sum test. RESULTS: The rate of both neutrophil and platelet engraftment was faster in children who underwent either partial or total splenectomy as compared with nonsplenectomized children (mean rates of neutrophil engraftment were 26, 19, and 19 days for the nonsplenectomy, total splenectomy, and partial splenectomy groups, respectively; mean rates of platelet engraftment were 97, 37, and 45 days for the nonsplenectomy, total splenectomy, and partial splenectomy groups, respectively). Graft-versus-host disease rates were similar between the 3 groups. The mean percentage of splenic regrowth after partial splenectomy was 39%. There were no perioperative complications. CONCLUSIONS: Partial splenectomy may be safely performed before HSC transplantation and, similar to total splenectomy, may improve the rate of HSC engraftment. Although this series has a limited number of patients, the use of partial splenectomy appears to be safe and may allow for splenic salvage to minimize the risk of postsplenectomy sepsis.

Duke Scholars

Published In

J Pediatr Surg

DOI

EISSN

1531-5037

Publication Date

January 2005

Volume

40

Issue

1

Start / End Page

221 / 227

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Splenectomy
  • Preoperative Care
  • Pediatrics
  • Male
  • Immunologic Deficiency Syndromes
  • Hypersplenism
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Hematologic Diseases
 

Citation

APA
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MLA
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Hall, J. G., Kurtzberg, J., Szabolcs, P., Skinner, M. A., & Rice, H. E. (2005). Partial splenectomy before a hematopoietic stem cell transplantation in children. J Pediatr Surg, 40(1), 221–227. https://doi.org/10.1016/j.jpedsurg.2004.09.047
Hall, Jennifer G., Joanne Kurtzberg, Paul Szabolcs, Michael A. Skinner, and Henry E. Rice. “Partial splenectomy before a hematopoietic stem cell transplantation in children.J Pediatr Surg 40, no. 1 (January 2005): 221–27. https://doi.org/10.1016/j.jpedsurg.2004.09.047.
Hall JG, Kurtzberg J, Szabolcs P, Skinner MA, Rice HE. Partial splenectomy before a hematopoietic stem cell transplantation in children. J Pediatr Surg. 2005 Jan;40(1):221–7.
Hall, Jennifer G., et al. “Partial splenectomy before a hematopoietic stem cell transplantation in children.J Pediatr Surg, vol. 40, no. 1, Jan. 2005, pp. 221–27. Pubmed, doi:10.1016/j.jpedsurg.2004.09.047.
Hall JG, Kurtzberg J, Szabolcs P, Skinner MA, Rice HE. Partial splenectomy before a hematopoietic stem cell transplantation in children. J Pediatr Surg. 2005 Jan;40(1):221–227.
Journal cover image

Published In

J Pediatr Surg

DOI

EISSN

1531-5037

Publication Date

January 2005

Volume

40

Issue

1

Start / End Page

221 / 227

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Splenectomy
  • Preoperative Care
  • Pediatrics
  • Male
  • Immunologic Deficiency Syndromes
  • Hypersplenism
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Hematologic Diseases