Splenectomy and death in renal transplant patients

To determine any association of splenectomy and death, 191 recipients of a single renal transplant were reviewed. Pretransplant splenectomy was performed in 90(47%) patients and the spleen was retained ("spleen-retaining") in 101 (53%). Sixty-eight patients (36%) died. Thirty-two fatal infections occurred in asplenic patients compared with ten infection-caused deaths in those retaining the spleen; 12 asplenic and 14 spleen-retaining patients died of noninfectious causes. Age, sex, graft source, HLA mismatch, and period of graft function were similar in asplenic and spleen-retaining patients who died. Prospective, multicenter, and single-center studies support divergent conclusions regarding the risks and benefits of splenectomy in transplantation. Study of specific center experience should precede adopting a policy of pretransplant splenectomy, an irreversible form of immunosuppression significantly related to fatal infection.