Long Term Outcome of Splenectomy in Chronic Immune Thrombocytopenic Purpura

Abstract

AIM: Splenectomy is the accepted second-line treatment in chronic immune thrombocytopenic purpura after corticosteroids fail. Splenectomy has a success rate of 50-60% in achieving complete remission. However, true long-term outcome is unknown since most of the follow-ups are around five years, according to other given publications. This retrospective review of adult patients with chronic ITP analyses true long term outcome of splenectomy over a long period and also examines for predictors of response to splenectomy.

METHODS: We retrospectively reviewed the medical records of 49 patients who had undergone splenectomy for chronic ITP from 1982 to 2015 [Range 2 - 396 months (33 years)] in a premier institute in south India. The mean follow-up period was 75.71 months.

RESULTS: Response to splenectomy gradually declined from 83.3% (five out of six patients) at one year to 25% (one out of four patients) when observed beyond 15 years, following splenectomy. Out of several factors studied like age, gender, initial response to steroids (pre-operative) and post-operative platelet count, there was no factor found to be statistically significant to predict long term remission. However, patients with post-splenectomy relapse could be managed with a significantly lower dose of prednisolone of 16.7 mg/day compared to their pre-splenectomy average requirement of 47.5 mg/day.

CONCLUSION: Although splenectomy normalizes platelet count acutely, sustained long term remission decreases with passage of time, to an extent only one-third ofpatients may remain in remission by 10 years of surgery. Further, there was no factor which could predict response to splenectomy.