Partial splenic embolization for hypersplenism in renal transplantation

Abstract

Immunosuppressive therapy is necessary in the treatment and prevention of rejection in renal transplant recipients. Unfortunately, these patients may become intolerant to this therapy when it is complicated by hypersplenism with leukopenia and/or thrombocytopenia. The therapy must then be either decreased or stopped, thus preventing adequate treatment or prevention or rejection. Splenectomy has been used to treat the hypersplenism to break this cycle. It requires operative intervention with general anesthesia and prolonged hospitalization, and has been associated with fulminant bacterial septicemia. For these reasons, partial splenic embolization was offered to our patients as an alternative to splenectomy in the treatment of their immunosuppressive therapy intolerance due to hypersplenism. Six patients with acute rejection episodes and one patient on dialysis awaiting transplantation underwent partial splenic embolization. It corrected the hypersplenism in each case without significant complications allowing control of the rejection episode with adequate immunosuppressive therapy in six patients. Strict aseptic technique, pain control, and antibiotic prophylaxis are advised to prevent the complications of splenic abscess, rupture, or septicemia when this technique is used.