IMMUNE RESTORATION IN CHILDREN AFTER PARTIAL SPLENECTOMY

Splenectomy (SE) is recognized to be a therapeutical approach in treat ing children with severe autoimmune diseases (chronic idiopathic throm bocytopenia; hemolytic anemia) or hypersplenism because of portal hype rtension. Nevertheless, removal of a main immune organ results in elev ated infection risk for these patients. Partial splenectomy (PSE) was developed as a therapeutical compromise to retain immunologically acti ve spleen tissue. Here, we document the analysis of immune parameters obtained from children after both partial and total splenectomy, which have been followed up for a period of more than 6 years: (i) Lymphocy tes from both groups of patients failed to produce IgG in response to pokeweed mitogen in vitro. This was observed in 11/20 splenectomized p atients even 10 years after operation, whereas in PSE patients a resto ration of this parameter after 1-2 years was seen. (ii) In patients af ter PSE, but not in splenectomized persons, an elevated number of HLA- class II positive cells had been detected suggesting a different situa tion of immune regulation following this operation. However, in parall el with an improvement of B cell in vitro activity this parameter was found to achieve normal values. Our findings indicate that partial spl enectomy may be a therapeutical alternative, if the therapeutic goal c an be achieved by this procedure.