Outcome of splenectomy for thrombocytopenia associated with systemic lupus erythematosus

Objective: To determine the efficacy of splenectomy for treating thrombocytopenia associated with systemic lupus erythematosus (SLE). Summary Background Data: The role of splenectomy has been controversial in this patient population. Methods: Between 1975 and 2001, 25 consecutive adults with SLE underwent splenectomy specifically for thrombocytopenia. Surgical indications, operative mortality and morbidity, and hematological outcomes were followed in both the short-term (first 30 days) and the long-term (last recorded platelet count, last contact, or death). Response to splenectomy was rated as: complete (CR: platelets greater than or equal to150 x 10(9)/L for at least 4 weeks), partial (PR: platelets 50-149 x 10(9)/L for at least 4 weeks), or none (NR: platelets < 50 x 10(9)/L at all times). Relapse occurred if platelets fell below 50 x 10(9)/L after CR or PR. Results: Indications for splenectomy included: thrombocytopenia refractory to (64%), dependent on (20%), or patient intolerance of (16%) medical treatments. Perioperative mortality was 0% and morbidity was 24%. After a median of 9.5 years, 9 patients (36%) had died, with only 1 death being secondary to bleeding. Early partial or complete response rate to splenectomy was 88%. After a median follow-up of 6.6 years, 16 (64%) patients had sustained complete or partial response without relapse. Eight (32%) of these patients required adjunctive medical therapy, whereas the other 8 (32%) did not. The remaining 9 (36%) patients relapsed, but 5 (20%) of the 9 patients were subsequently salvaged to at least partial response with further treatments. The overall PR or CR to splenectomy combined with medical therapy was 84%. Conclusion: Splenectomy should be considered safe and efficacious for thrombocytopenia associated with SLE.