Allotransplantation of whole spleen in patients with hepatic malignant tumors or hemophilia A. Operative technique and preliminary results
D. L. Liu, S. Xia, J. Tang, X. Qin and H. Liu
Institute for Organ Transplantation, Tongji Hospital, Tongji Medical University, Wuhan, China.
BACKGROUND: It has been reported that the spleen performs a vital function
in the fight against malignant tumors. The spleen is the primary producer
of tuftsin, which can directly or indirectly kill tumor cells or inhibit
their growth. The spleen is also believed to produce coagulating factor
VIII. Therefore, allotransplantation of the spleen can be used in the
treatment of patients with malignant tumors and hemophilia A. DESIGN:
Heterotopic allotransplantation of whole spleen was performed in six
patients with advanced hepatocellular carcinoma and hemophilia A. An
adjuvant immunotherapy with interferon alfa was simultaneously administered
in the patients with liver cancer. SETTING: Tongji Hospital, Tongji Medical
University, Wuhan, China. RESULTS: Among six cases of allografting of whole
spleen, five grafts were successful; one failed because of torsion of the
splenic hilum. Three patients with hepatocellular carcinoma survived 9, 11,
and 5 months after transplantation. Marked shrinkage of hepatic tumors and
reduced serum alpha-fetoprotein levels were observed in these patients. On
5-year follow-up, three patients with hemophilia who had undergone splenic
allografts were alive, and two had experienced substantial clinical
improvement. In these two patients, when the grafts were functioning well
and the recipients were free of acute rejection or graft-vs-host reaction,
the mean plasma factor VIII activity remained between 30% and 36%, with
peak factor VIII activities of 53.7% and 66.6%. We also evaluate operative
technique and posttransplantation complications. CONCLUSION: Our results
strongly imply that the spleen is one of the primary sites of synthesis of
factor VIII and that the spleen has an inherent ability to fight malignant
diseases. Allografting of whole spleen may be a promising technique for the
treatment of patients with unresectable hepatocellular carcinoma and severe
hemophilia A.
