LATE RESULTS OF HETEROTOPIC AUTOTRANSPLANTATION OF SPLENIC TISSUE INTO THE GREATER OMENTUM

There is still controversy about the beneficial effects of splenic aut otransplantation. As a result, replantation of the spleen has almost b een abandoned for surgical treatment of splenic injuries. To learn mor e about the long-term effects we have analyzed eight patients 9.2 +/- 1.2 years after autotransplantation of the spleen into the greater ome ntum. Splenic replants could be detected by scintigraphy in seven pati ents (87.5%). Splenic size, measured by single-photon emission compute d tomography, varied between 19.344 and 471.705 units of volume (UoV), Two patients with the smallest replants had pathologic changes of leu kocytes and lymphocyte subsets in 12 of 16 measurements (75%). These c hanges closely resembled a spleenless state and were similar to those in the patient with no detectable splenic autograft. In contrast, five patients with large splenic replants (49.192-471.705 UoV) revealed pa thologic findings in only 2 of 40 measurements (5%). Based on an exten sive review of the literature and our own results, it can be concluded that splenic autotransplantation into the greater omentum is superior to splenectomy but undoubtedly less effective than in situ preservati on of the spleen. Therefore splenic replantation should still be consi dered, particularly in pediatric surgery, when in situ preservation of the spleen is not possible by other techniques.