Splenectomy and extraperitoneal splenic slice grafting in the treatment of thalassemia

ABSTRACT

The risk of total splenectomy in children with thalassemia is septicemia and overwhelming infection. Splenectomy with splenic slice grafting is an alternative in patients with thalassemia. 16 transfusion-dependent, high risk thalassemic patients [10 boys and 6 girls] underwent splenectomy and splenic slice grafting by the same surgeon from March 1998 to September 2001 at Health Insurance Hospital for children [Abu-Elrish Pupil Hospital], and El Hussein University Hospital. The patients age ranged from 4 to 8 years. The need for splenectomy in these cases was determined by the increasing need for blood transfusions and hypersplenism. Follow-up was from 1 to 4 years. Pre-and postoperative blood transfusions, length of operation, postoperative complications, fate of the grafts and their immune status before and after operation were evaluated. The procedure had good advantages of splenectomy and immunoconservation. Functioning splenic slice grafting which is detected by immunological assay and normal radionuclide splenic scan. Postoperatively there were no systemic infections or overwhelming post splenectomy sepsis. There was no incidence of death or rejection of the grafts during the follow-up period in our series. Splenectomy with splenic slice grafting greatly reduces and in some cases eliminates, the need for blood transfusions