Abstract
Purpose Restoration of the balance between T lymphocyte subsets and between Th1/Th2 cytokines together with improvement of antitumor immunity has been reported after hepatosplenectomy in patients with liver cirrhosis (LC) and hepatocellular carcinoma (HCC). However, the detailed effects of partial splenic embolization (PSE) on host immunity are unknown. Accordingly, this study evaluated host immunity in patients with cirrhosis receiving PSE for thrombocytopenia. Methods Twenty-three adult Japanese patients with cirrhosis and thrombocytopenia underwent PSE using straight coils at our hospital between 2010 and 2015. Blood samples were collected before PSE and 4 weeks after PSE. Results The platelet counts were significantly higher 4 weeks after PSE compared with before PSE. The white blood cell count (neutrophils, lymphocytes, and monocytes) also increased significantly after PSE. Furthermore, Th1 cells and Th2 cells showed a significant increase at 4 weeks after PSE compared with before PSE, although there was no significant change of Treg cells. Moreover, serum levels of TNF-alpha, soluble TNF receptor I, and soluble Fas were significantly increased after PSE. There was no significant change of the Child-Pugh score. Conclusions In patients with cirrhosis and thrombocytopenia, PSE not only promoted the recovery of leukopenia and thrombocytopenia but also induced activation of host immunity.
Highlights
Splenectomy is considered to be associated with a potential risk of infection, it is effective in increasing the platelet count
In patients with cirrhosis and thrombocytopenia undergoing Partial splenic embolization (PSE), this study demonstrated significant elevation of the white blood cell (WBC) count after embolization compared to before embolization that reflected an increase in neutrophils, lymphocytes, and monocytes
Bone marrow hyperplasia was reported in hypertensive patients with cirrhosis and hypersplenism [19], while serum levels of M-CSF and GM-CSF were significantly reduced by subtotal splenectomy in cirrhosis patients with splenomegaly secondary to portal hypertension [20]
Summary
Splenectomy is considered to be associated with a potential risk of infection, it is effective in increasing the platelet count. PSE increases the platelet counts and ameliorates portal hypertension and reduces esophageal varices by decreasing blood flow from the splenic vein [6]. Splenectomy does not impair T cell function in patients with hepatocellular carcinoma (HCC) and liver cirrhosis but promotes recovery of the balance between T lymphocyte subsets, and Th1/Th2 cytokines improve antitumor immunity [10]. Some studies have examined differences in immunocompetence after embolization or splenic injury [11,12,13,14], it is not clear how PSE influences host immunity in patients with thrombocytopenia.
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