{
    "abstract": "Splenectomy is frequently performed in transfusion-dependent thalassemia (TDT) patients to lower blood transfusion needs but is associated with significant long-term complications, including sepsis, thrombosis, and pulmonary hypertension. This study examines the long-term complications, survival rates, and causes of mortality among adult patients with TDT who have undergone splenectomy in a low and middle-income country (LMIC).\nA retrospective analysis was conducted on 103 adult TDT patients (\u226518 years) who underwent splenectomy between July 2013 and March 2024. Data collected included demographic and clinical characteristics, haematological parameters, transfusion requirements before splenectomy and at the last follow-up, survival rates, complications, and mortality causes.\nThe median age at splenectomy was 12 years (range 5-34). The majority (98\u202f%) underwent open splenectomy. The yearly transfusion volume decreased from 276.7\u202fml/kg/year pre-splenectomy (range 207-433) to 146.2 (range 0-252.9) post-splenectomy at the last follow-up, p\u202f<\u202f0.0001. Three patients were completely transfusion-free at the last follow-up. Complications included pulmonary hypertension in 10 (9.7\u202f%), thrombosis in 5 (4.8\u202f%), and overwhelming post-splenectomy infection (OPSI) in 4 (3.9\u202f%). The iron-overload-related complications included cardiomyopathy in 17 (16.5\u202f%), endocrinopathy in 56 (54.3\u202f%), chronic liver disease in 15 (14.5\u202f%) and hepatocellular carcinoma in 2 (0.9\u202f%). The 15-year post-splenectomy overall survival (OS) was 84.7\u202f% (95\u202f% CI- 77.3\u202f% - 92.8\u202f%), with 17 deaths (16.5\u202f%) recorded. Iron-overload-related cardiomyopathy was the leading cause of death in 8 (53.3\u202f%).\nSplenectomy significantly reduces transfusion requirements in TDT patients but is associated with risks such as thrombosis, pulmonary hypertension, and OPSI. Long-term mortality is primarily driven by iron-overload-related cardiomyopathy.",
    "authors": [
        {
            "affiliation": "Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research,\u00a0Chandigarh,\u00a0India.",
            "firstname": "Urmimala",
            "initials": "U",
            "lastname": "Bhattacharjee"
        },
        {
            "affiliation": "Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research,\u00a0Chandigarh,\u00a0India. Electronic address: hematacademics@gmail.com.",
            "firstname": "Alka",
            "initials": "A",
            "lastname": "Khadwal"
        },
        {
            "affiliation": "Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research,\u00a0Chandigarh,\u00a0India.",
            "firstname": "Charanpreet",
            "initials": "C",
            "lastname": "Singh"
        },
        {
            "affiliation": "Department of Pediatric Hematology and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.",
            "firstname": "Deepak",
            "initials": "D",
            "lastname": "Bansal"
        },
        {
            "affiliation": "Department of Pediatric Hematology and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.",
            "firstname": "Amita",
            "initials": "A",
            "lastname": "Trehan"
        },
        {
            "affiliation": "Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.",
            "firstname": "Thakur Deen",
            "initials": "TD",
            "lastname": "Yadav"
        },
        {
            "affiliation": "Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research,\u00a0Chandigarh,\u00a0India.",
            "firstname": "Arihant",
            "initials": "A",
            "lastname": "Jain"
        },
        {
            "affiliation": "Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research,\u00a0Chandigarh,\u00a0India.",
            "firstname": "Gaurav",
            "initials": "G",
            "lastname": "Prakash"
        },
        {
            "affiliation": "Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.",
            "firstname": "Prashant",
            "initials": "P",
            "lastname": "Sharma"
        },
        {
            "affiliation": "Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.",
            "firstname": "Reena",
            "initials": "R",
            "lastname": "Das"
        },
        {
            "affiliation": "Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research,\u00a0Chandigarh,\u00a0India.",
            "firstname": "Pankaj",
            "initials": "P",
            "lastname": "Malhotra"
        }
    ],
    "conclusions": "Splenectomy significantly reduces transfusion requirements in TDT patients but is associated with risks such as thrombosis, pulmonary hypertension, and OPSI. Long-term mortality is primarily driven by iron-overload-related cardiomyopathy.",
    "copyrights": "Copyright \u00a9 2025 Elsevier Ltd. All rights reserved.",
    "doi": "10.1016/j.transci.2024.104064",
    "journal": "Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis",
    "keywords": [
        "Overwhelming post-splenectomy infection",
        "Pulmonary hypertension",
        "Splenectomy",
        "Thrombosis",
        "Transfusion-dependent thalassemia"
    ],
    "methods": null,
    "publication_date": "2025-01-10",
    "pubmed_id": "39787843",
    "results": "The median age at splenectomy was 12 years (range 5-34). The majority (98\u202f%) underwent open splenectomy. The yearly transfusion volume decreased from 276.7\u202fml/kg/year pre-splenectomy (range 207-433) to 146.2 (range 0-252.9) post-splenectomy at the last follow-up, p\u202f<\u202f0.0001. Three patients were completely transfusion-free at the last follow-up. Complications included pulmonary hypertension in 10 (9.7\u202f%), thrombosis in 5 (4.8\u202f%), and overwhelming post-splenectomy infection (OPSI) in 4 (3.9\u202f%). The iron-overload-related complications included cardiomyopathy in 17 (16.5\u202f%), endocrinopathy in 56 (54.3\u202f%), chronic liver disease in 15 (14.5\u202f%) and hepatocellular carcinoma in 2 (0.9\u202f%). The 15-year post-splenectomy overall survival (OS) was 84.7\u202f% (95\u202f% CI- 77.3\u202f% - 92.8\u202f%), with 17 deaths (16.5\u202f%) recorded. Iron-overload-related cardiomyopathy was the leading cause of death in 8 (53.3\u202f%).",
    "title": "Long-term complications, survival and mortality in splenectomised adult transfusion-dependent thalassemia patients.",
    "xml": "<Element 'PubmedArticle' at 0x788504be5df0>"
}