Allotransplantation of whole spleen in patients with hepatic malignant tumors or hemophilia A. Operative technique and preliminary results.

BACKGROUND

It has been reported that the spleen performs a vital function in the fight against malignant tumors. The spleen is the primary producer of tuftsin, which can directly or indirectly kill tumor cells or inhibit their growth. The spleen is also believed to produce coagulating factor VIII. Therefore, allotransplantation of the spleen can be used in the treatment of patients with malignant tumors and hemophilia A.

DESIGN

Heterotopic allotransplantation of whole spleen was performed in six patients with advanced hepatocellular carcinoma and hemophilia A. An adjuvant immunotherapy with interferon alfa was simultaneously administered in the patients with liver cancer.

SETTING

Tongji Hospital, Tongji Medical University, Wuhan, China.

RESULTS

Among six cases of allografting of whole spleen, five grafts were successful; one failed because of torsion of the splenic hilum. Three patients with hepatocellular carcinoma survived 9, 11, and 5 months after transplantation. Marked shrinkage of hepatic tumors and reduced serum alpha-fetoprotein levels were observed in these patients. On 5-year follow-up, three patients with hemophilia who had undergone splenic allografts were alive, and two had experienced substantial clinical improvement. In these two patients, when the grafts were functioning well and the recipients were free of acute rejection or graft-vs-host reaction, the mean plasma factor VIII activity remained between 30% and 36%, with peak factor VIII activities of 53.7% and 66.6%. We also evaluate operative technique and posttransplantation complications.

CONCLUSION

Our results strongly imply that the spleen is one of the primary sites of synthesis of factor VIII and that the spleen has an inherent ability to fight malignant diseases. Allografting of whole spleen may be a promising technique for the treatment of patients with unresectable hepatocellular carcinoma and severe hemophilia A.