Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura

Background: Splenectomy has been shown to produce longterm remission in pat ients with immune thrombocytopenic purpura (ITP). With the development of l aparoscopic splenectomy, there is renewed interest in the surgical treatmen t of ITP. The aim of this study was to identify factors that are predictive of outcome after laparoscopic splenectomy for ITP. Methods: A case series of 67 consecutive patients with ITP undergoing lapar oscopic splenectomy was reviewed. A positive response was defined as a post operative platelet count greater than 150,000/mul requiring no maintenance medical therapy on follow-up evaluation. A chi-square test and a stepwise l ogistic regression analysis were performed for the following variables: age , gender, preoperative response to steroids, duration of disease, severity of preoperative bleeding, accessory spleens, and thrombocytosis on discharg e. Results: At a median follow-up period of 38 months (range, 2-56 months), 52 patients (78%) had a positive response to laparoscopic splenectomy. Of the 15 patients (22%) who did not have a positive response, 11 were refractory and 4 relapsed. All relapses occurred in patients with a platelet count le ss than 150,000/mul at discharge. Patient age was the most significant pred ictive factor for success or failure of the operation. The median age of th e responders (31 years; range, 19-71 years) was significantly lower than th e median age of the nonresponders (49 years; range, 24-62; p < 0.001). Only 5.6% of those younger than 40 years did not have a positive response, comp ared with 42% of patients older than 40 years (p < 0.05). Patient age was s ignificantly associated with outcome on univariable chi-square analysis (p = 0.001), and was the only significant factor on multivariable analysis (od ds ratio, 2.65; 95% confidence interval, 1.71-4.1). Other significant predi ctors of outcome on uni variable analysis were preoperative response to cor ticosteroids and platelet count on discharge. Conclusions: A long-lasting response after splenectomy for ITP is more like ly to occur in patients younger than 30 years of age. To avoid the long-ter m side effects of corticosteroid use, early surgical referral of younger pa tients with ITP should be considered.