Long-Term Immune Function Following Splenic Artery Embolisation for Blunt Abdominal Trauma
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LETTER TO THE EDITOR
Long-Term Immune Function Following Splenic Artery Embolisation for Blunt Abdominal Trauma Matthew Lukies1 • Helen Kavnoudias1 • Adil Zia1 • Robin Lee1 • Julian J. Bosco2 Tim Joseph1 • Warren Clements1,3,4
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Received: 21 July 2020 / Accepted: 7 August 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Dear editor, The spleen is a commonly injured solid viscus in blunt abdominal trauma. Splenic artery embolisation has now become the preferred method of treatment in haemodynamically stable patients [1]. Compared to splenectomy, embolisation provides preservation of splenic function. Short-term follow-up of splenic immune function after embolisation for blunt trauma was assessed in a previous study at our institution at a median of 6.5 months (range 6–20 months) after embolisation [2] using IgM memory B cell levels as a quantitative measure [3]. After further institutional ethics approval, these patients were invited for longer-term follow-up. We recruited patients at a median of 102 months (8.5 years; range 7–13 years) since embolisation, and we would like to present this update. IgM memory B cell levels (percentage of lymphocytes and percentage of B cells) and splenic volume via ultrasound were both assessed.
& Warren Clements [email protected] 1
Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
2
Department of Respiratory Medicine-Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
3
Department of Surgery, Monash University, Melbourne, VIC, Australia
4
National Trauma Research Institute, Monash University Central Clinical School, Melbourne, VIC, Australia
Of the 49 patients who were evaluated previously, 9 patients were recruited for longer-term follow-up. One patient was excluded due to a new diagnosis of chronic immune disease unrelated to trauma. Seven patients received proximal embolisation, and one distal embolisation (Table 1). There were 5 females and 3 males in the cohort, with median age of 35 years (range 18 to 67 years). The majority (6) of injuries were sustained in road traffic accidents, with the remaining injuries from alleged assault (1) and sports (1). The median grade of splenic injury was American Association for the Surgery of Trauma (AAST) grade IV (range III to V). In two patients, the re-classified 2018 AAST grading was higher than the 1994 grading applied at the time of treatment [4]. Median IgM memory B cells as percentage of total lymphocytes was 2.52 (range of 1.53–4.29) and median IgM memory B cells as percentage of total B Cells was 20.0 (range of 5.20–33.0). Compared to initial short-term assessment, there was a significant increase in IgM memory B cells expressed as both percentage of lymphocytes (p = 0.020) and as percentage of B cells (p = 0.015) (Figs. 1, 2). Of note, there was one individual who initially had IgM memory B cell levels of 0.8 (%lymphocytes) and 4.8
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