Spleen
Removal Can Help Hepatitis C Patients with Cirrhosis Tolerate Treatment By
Liz Highleyman Many
individuals with cirrhosis related to
chronic hepatitis C have low Model for End-Stage Liver Disease (MELD) scores,
which are used to prioritize patients for liver
transplantation. While it is too early for such patients to undergo transplants,
they may have too advanced thrombocytopenia (low platelet levels) to safely receive
interferon. The
spleen is an abdominal organ that removes old blood cells from circulation. Patients
with cirrhosis often have an enlarged spleen (splenomegaly) that removes too many
thrombocytes (platelets), cells necessary for blood clotting. This can lead to
excessive bleeding or bruising. Hepatitis C therapy with
interferon plus ribavirin can be dangerous in patients with thrombocytopenia.
Removal of the spleen (splenectomy) may be performed to correct this condition. In
the September 2006 Journal of Clinical Gastroenterology, researchers reported
on a series of cases in which splenectomy was performed to raise platelet counts
so that cirrhotic hepatitis C patients could be treated with pegylated
interferon plus ribavirin. The
authors conducted a retrospective chart and computer record review that identified
7 such patients; 4 were men, 3 were women, and the average age was 45 years. All
underwent elective splenectomy for thrombocytopenia before starting treatment
regimens containing pegylated
interferon-alpha 2b (Peg-Intron). Prior
to splenectomy, all had thrombocytopenia contraindicating anti-HCV therapy. Most
patients (5) had Child's-Pugh Class A cirrhosis, while 2 had Class B. Results 
All 7 patients experienced increases in their platelet counts by an average of
221 days after spleen removal (mean increase 32,400 to 222,140 cells/mL; P <
0.01).
The median hospital stay was 9 days (range 4-25).
The median amount of blood loss was 750 mL (100 to 2500 mL); patients required
varying amounts of replacement platelet packs, units of packed red blood cells,
and fresh frozen plasma (ranging from 0-14 units).
There were no deaths or cases of portal vein thrombosis.
1 patient who had already received a liver transplant had significant morbidity.
5 patients were able to complete therapy with pegylated interferon plus ribavirin;
1 was still on therapy at the time of the report, and 1 was awaiting treatment
initiation.
Of the 5 who completed therapy: -
2 achieved sustained virological response;
- 1 was a non-responder;
- 1
experienced HCV breakthrough during therapy;
- 1 experience HCV relapse after
completing therapy.
Conclusion The
authors concluded that, "Splenectomy in patients with hepatitis C cirrhosis
can be done safely to allow application of antiviral treatment and potentially
avoid transplantation." They
added that splenectomy "may be considered in patients with Child's-Pugh A
cirrhosis, no prior abdominal surgeries, and with non-1 HCV viral genotype."
It was not clear from the report why the procedure would not be expected to also
benefit patients with genotype 1 HCV.
9/19/06 Reference
P
H Hayashi, C Mehia, H J Reimers, and others. Splenectomy for Thrombocytopenia
in Patients With Hepatitis C Cirrhosis. Journal of Clinical Gastroenterology
40(8): 740-744. September 2006.
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