Partial splenectomy before a hematopoietic stem cell transplantation in children
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Updated: Aug 18, 2026
Robot-Assisted Laparoscopic Splenectomy In Children: A Case Report with Literature Review
Published on: March 27, 2026
Jennifer G Hall1, Joanne Kurtzberg, Paul Szabolcs
1Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Insights
Partial splenectomy before hematopoietic stem cell transplantation (HSCT) in children with hypersplenism safely improves engraftment times. This approach may reduce sepsis risk by preserving spleen function.
Area of Science:
- Pediatric Hematology
- Transplant Surgery
- Immunology
Background:
- Hypersplenism can delay hematopoietic stem cell (HSC) engraftment in children.
- Total splenectomy improves engraftment but carries a risk of postsplenectomy sepsis.
- Partial splenectomy is explored as a safer alternative for spleen preservation.
Purpose of the Study:
- To evaluate the safety and efficacy of partial splenectomy before HSC transplantation in children with hypersplenism.
- To compare engraftment rates and complications with nonsplenectomized and total splenectomized patients.
Main Methods:
- A retrospective study of five children undergoing partial splenectomy before HSC transplantation.
- Comparison of neutrophil and platelet engraftment rates, graft-versus-host disease, and infection rates.
- Outcomes analyzed against age-matched controls and total splenectomy cases using Wilcoxon's rank sum test.
Main Results:
- Partial splenectomy was associated with faster neutrophil and platelet engraftment compared to nonsplenectomized children.
- Engraftment rates after partial splenectomy were comparable to total splenectomy.
- No perioperative complications were observed; mean splenic regrowth was 39%.
Conclusions:
- Partial splenectomy is a safe procedure prior to HSC transplantation in children with hypersplenism.
- It effectively improves HSC engraftment rates, similar to total splenectomy.
- Partial splenectomy offers spleen salvage, potentially mitigating the risk of postsplenectomy sepsis.
Unlabelled:
Hematopoietic stem cell (HSC) engraftment is delayed in children with hypersplenism, and splenectomy may improve HSC engraftment. However, the use of total splenectomy in children is limited because of concerns for postsplenectomy sepsis. In this study, the authors sought to assess the role of partial splenectomy for children with hypersplenism undergoing HSC transplantation.
Methods:
Five children with a variety of conditions and associated hypersplenism underwent partial splenectomy before an HSC transplantation at the authors' institution between 2000 and 2003. Primary outcome measures were rates of neutrophil and platelet engraftment. Secondary outcome measures included perioperative complications, splenic regrowth, graft-versus-host disease, and infection rate. All outcomes were compared with recipients of an HSC transplant from both age-matched nonsplenectomized children (n = 497) and hypersplenic children who underwent total splenectomy (n = 10). Outcomes were compared using Wilcoxon's rank sum test.
Results:
The rate of both neutrophil and platelet engraftment was faster in children who underwent either partial or total splenectomy as compared with nonsplenectomized children (mean rates of neutrophil engraftment were 26, 19, and 19 days for the nonsplenectomy, total splenectomy, and partial splenectomy groups, respectively; mean rates of platelet engraftment were 97, 37, and 45 days for the nonsplenectomy, total splenectomy, and partial splenectomy groups, respectively). Graft-versus-host disease rates were similar between the 3 groups. The mean percentage of splenic regrowth after partial splenectomy was 39%. There were no perioperative complications.
Conclusions:
Partial splenectomy may be safely performed before HSC transplantation and, similar to total splenectomy, may improve the rate of HSC engraftment. Although this series has a limited number of patients, the use of partial splenectomy appears to be safe and may allow for splenic salvage to minimize the risk of postsplenectomy sepsis.
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