TNF-alpha releasing capacity of the whole blood drops after open total splenectomy, but increases after partial/subtotal or minimally invasive splenectomy

Abstract

Background

The mechanisms that induce immunodeficiency after splenectomy remain unknown. The aim of this study was to measure the cytokine releasing capacity of the whole blood as an expression of the innate immunity after total (TS) and subtotal/partial splenectomy (S/PS) in order to assess the impact of splenectomy on the individual cytokine reactivity.

Methods

We prospectively collected blood before (D0) and at multiple time points after splenectomy (7 days - D7, 30 days - D30, 90 days - D90, 180 days - D180, and 360 days - D360) and measured the cytokines releasing capacity of IL-6, TNF-alpha and IL-10 from whole blood under LPS stimulation which we normalized to the monocytes number.

Results

When analyzing all splenectomies at D0, D7 and D30, normalized ΔTNF-alpha significantly dropped after splenectomy (p = .0038) and normalized ΔIL-6 and ΔIL-10 did not significantly change. More specifically, normalized ΔTNF-alpha dropped after TS (p = .0568) and significantly increased after S/PS (p = .0388). Open surgery induced a decrease in normalized ΔTNF-alpha (p = .0970), whereas minimally invasive (MI) surgery significantly increased the normalized ΔTNF-alpha releasing capacity (p = .0178). The cytokine levels were heterogenous between pathologies at D0, and ΔIL-6 dropped mainly in cirrhotic patients after splenectomy (all underwent TS), ΔTNF-alpha dropped in immune thrombocytopenic purpura patients (all underwent TS), but increased in spherocytosis (91% underwent S/PS) after splenectomy.

Conclusions

Splenectomy induces a decrease of the pro-inflammatory cytokine TNF-alpha and if splenic parenchyma is spared and the surgery is performed MI, this change is hindered.

Keywords:

• Cytokines
• tumor necrosis factor-alpha
• minimally invasive
• parenchyma spearing
• splenectomy

Compliance with ethical standards

Ethical approval: The study protocol was approved by the Ethics Committee of Fundeni Clinical Hospital. Informed consent: Each patient gave informed consent for participating to this research project.

Acknowledgements

The authors thank all surgeons who provided samples for this study.

Disclosure statement

Mihnea P. Dragomir, Stefan Tudor, Monica Lacatus, Oana Stanciulea, Bogdan Trandafir, Adriana Diaconu, Daniel Coriu, Anca Colita, Gabriela Droc, Raluca Purnichescu-Purtan, George A. Calin, Catalin Vasilescu declare that they have no conflict of interest.

Author contributions

Mihnea P. Dragomir, Stefan Tudor and Catalin Vasilescu have given substantial contributions to the conception or the design of the manuscript, Mihnea P. Dragomir, Stefan Tudor, Oana Stanciulea, Monica Lacatus, Bogdan Trandafir, Adriana Diaconu, Daniel Coriu, Anca Colita, Gabriela Droc, Raluca Purnichescu-Purtan, George A. Calin, and Catalin Vasilescu have contributed to acquisition, analysis and interpretation of the data. All authors have participated to drafting the manuscript, and authors Catalin Vasilescu, George A. Calin revised it critically. All authors read and approved the final version of the manuscript.

Additional information

Funding

Dr. Vasilescu and Dr. Tudor were supported in part by grant CEEX 187/2006 (The Program for Excellence in Research) and by Ministry of National Education, CNCS‐UEFISCDI project number 22 from 28/08/2013 [PN‐II‐ID‐PCE‐2012‐4‐0018].