Splenic function is not maintained long-term after partial splenectomy in children with sickle cell disease

Area of Science:

• Surgical outcomes
• Hematology
• Pediatric surgery

Background:

• Partial splenectomy (PS) aims to preserve splenic function when splenectomy is necessary for hematologic conditions.
• Long-term outcomes of PS in sickle cell disease (SCD) are not well-established.

Purpose of the Study:

• To investigate the long-term viability of splenic remnants after partial splenectomy (PS) in children with sickle cell disease (SCD).
• To compare outcomes with PS in patients with hereditary spherocytosis (HS).

Main Methods:

• Retrospective chart review of children with SCD undergoing PS (1997-2017).
• Comparison group: patients with HS undergoing PS.
• Primary endpoint: splenic remnant viability assessed by perfusion on ultrasound and/or liver spleen scan.

Main Results:

• Nine SCD patients and 26 HS patients underwent PS.
• No SCD patients maintained a functioning splenic remnant beyond 42 months post-surgery, with median loss at 12.6 months.
• In contrast, all HS patients demonstrated sustained splenic remnant perfusion with a median follow-up of 46 months.

Conclusions:

• Partial splenectomy (PS) does not lead to long-term preservation of splenic function in patients with sickle cell disease (SCD).
• Continued autoinfarction, characteristic of SCD, likely causes loss of splenic remnant viability.
• PS is not indicated for preserving splenic function in SCD patients.