Italian doctors successfully transplant a kidney in the place of the spleen | Hacker News Reader

Italian doctors successfully transplant a kidney in the place of the spleen

thelocal.it

141 pointsvanni71 comments

I just want to point our that the title, "Italian doctors transplant kidney for spleen," remains misleading, to my eyes. This isn't as interesting as it sounds.

The patient had renal failure and needed a transplant. Due to vascular anatomy, it sounds like the lower abdomen was not an appropriate place for a new transplanted kidney.

The innovative technique was to sacrifice the spleen to create a space for the kidney, then to use the intact splenic vasculature to hook up to the transplanted kidney.

The spleen is a lymphoid organ that people can live without. Many people with sickle cell disease are "functionally" asplenic. It can be removed after injury. Etc. It's a highly vascular organ and has a robust supply via the splenic artery.

In no way does the kidney perform the function of the spleen.

Thanks, we've updated the title again to help clarify.

The current title is still misleading as it overcorrected in the other direction: now it sounds like the doctors made a mistake.

If the word "innovative" sounds like inappropriate - which I am not sure why that would be the case, given this was a "first-ever" technique, at least "successfully" should be added in the title to avoid it sounding like there was a mishap.

Yes, thank you. We've added "successfully".

I would change it to "Italian doctors graft kidney to splenic vasculature, sacrificing immune function for intra-abdominal real estate".

The title should be "Italian doctors graft kidney to splenic vasculature, sacrificing immune function for intra-abdominal real estate".

Darn. I had my spleen removed years ago and was really hopeful to not worrying about sick people every year.

Maybe someday...

Other sources:

http://www.thelocal.it/20161214/italian-doctors-transplant-k...

http://torino.repubblica.it/cronaca/2016/12/14/news/torino_t... [ITALIAN]

The Italian link has more info. Thanks. Autotransaltion: https://translate.google.com/translate?sl=auto&tl=en&u=http%...

Two more sources:

http://www.lastampa.it/2016/12/14/cronaca/un-rene-al-posto-d... [ITALIAN]

http://tg24.sky.it/tg24/scienze/2016/12/14/torino-primo-trap... [ITALIAN]

Ok, we'll use the first of those instead of http://www.ansa.it/english/news/science_tecnology/2016/12/14... since it has a bit more information.

If there's a better URL we can change it again.

As a French-speaking person, I was a bit confused by the word "Spleen", as it means something akin to "Melancholy" in French (it was mostly used by Renaissance poets like Beaudelaire), but I always assumed it was an anglicism or something so I really wasn't expecting it to be a body part.

What's kind of funny is that the French word for this organ, "rate", is used in the idiom "Se dilater la rate", which means laughing a lot.

So the same organ's name is related to both sadness and laughter, depending on the language.

I now realize that I still don't know what a spleen is or what it does in the body; time to fire up Wikipedia!

You are in for a surprise. The spleen is a very big and very important organ that goes largely unnoticed.

I've lived the last 26 years without a spleen, with none of the immunological problems that various physicians threatened. The importance of the spleen exceeds that of the appendix, but only just.

The truth is that I had confused it with the pancreas.

My spleen hurts when I laugh a lot :) (Not really, just that part of my body)

There is actually a reason for this that follows back all the way to the middle ages belief that your body needed to be in balance, and black bile produced in the spleen was one of the components of that balance.

Granted I was reading about this last night, but I can't remember it to the full extent now.

Unfortunately, that's a bit of a false etymology! According to humorism, black bile [1] comes from the gallbladder, not the spleen. The spleen was supposed to produce yellow bile, an excess of which was thought to cause aggression and anger.

[1] Black bile is actually the source of the term "melancholy" — from the Greek melankholia, from melan- ("black") and kholē ("bile")!

The issue with spleen and black bile in humoralism isn't that it overproduces it, which it doesn't, but rather that it overaccumulates it.

>“The gall, placed in the concave of the liver, extracts choler to it: the spleen, melancholy; which is situate on the left side, over against the liver, a spongy matter, that draws this black choler to it by a secret virtue [emphasis mine], and feeds upon it, conveying the rest to the bottom of the stomach, to stir up appetite, or else to the guts as excrement.”

~ Robert Burton, Anatomy of Melancholy

I didn't know until I looked at a dictionary just now that "spleen" can mean "melancholy" in English too... The more common emotional meaning would be something more like "spite" or "anger"; hence the adjective "splenetic". One gets the impression that each different emotion associated with this word corresponds to a different idiosyncratic medieval theory about the emotions originating in the viscera.

https://en.wikipedia.org/wiki/Galen#Contributions_to_medicin...

Galen and Hippocrates vital humors theory

English has an idiom "to vent one's spleen", for a public and obvious display of anger.

Yeah, I suppose the transplant recipient will have to vent her kidney from now on.

I think you meant she'll have to get pissed off.

The tl;dr; is that the spleen is mostly responsible for "macro" filtering of the blood. It removes relatively large foreign bodies, as well as red blood cells that are starting to wear out (they last 3-4 months, on average before getting filtered out).

Because of its role, there are many blood vessels in the spleen, making it very prone to bleeding if it is damaged. It (along with the liver) is one of the more common sites of serious internal bleeding after physical trauma.

Just FYI: Baudelaire died in 1867, and was born in the 182x.

Not exactly "Renaissance".

(I'm also French, but my litterature teacher had explained that "spleen" was an organ in English)

Yeah, I saw that after posting, looks like I got my historical periods mixed up. Thanks anyway!

> So the same organ's name is related to both sadness and laughter, depending on the language.

... and in German it's related to craziness. "Einen Spleen haben" literally "Having a spleen" means someone is quirky or eccentric.

And I was expecting a malpractice mix-up. Can any biologist folk explain how this is possible?

Weird. IIUC, it looks like they removed (partially?) the spleen to get some room to put an additional kidney, not to replace the functionality of the spleen. Do someone has a link with more info? Can any biologist/medic folk explain more???

I don't think this can be the whole story. Normally when a kidney is transplanted into a patient, the defective kidneys are not removed (adds unnecessary risk). There is plenty of space to add a kidney without removing the spleen so there must be more to this!

Her young age, and thus minimal body development, may have limited the extra space needed...?

Yep, and in particular it's not difficult to get sufficient access to circulatory system.

http://my.clevelandclinic.org/health/treatments_and_procedur...

We definitely need more info.

EDIT: Actually, looks like it was in fact an issue of space and blood vessels. From the Google-translation of the Italian article linked elsewhere in the comments:

> The particular malformation of the baby made it impossible for the kidney system donated by the classic conventional technique. The only option then was to use another way of connecting to the bloodstream....In order to create the necessary space for the new kidney, a revolutionary surgical technique which involved the removal of the spleen and the installation of the kidney on splenic vessels of the spleen itself along their course behind the pancreas was applied. The ureter of the transplanted kidney was then implanted directly on the bladder.

https://translate.google.com/translate?sl=auto&tl=en&u=http%...

Oh how interesting! Thanks for the link!

Sounds like (from the Italian article) she had already had an unsuccessful (or attempted?) kidney transplant in 2014. The patient appears to have some sort of vascular as well as immunological issues (again, my broken translation from the Italian).

When the donor kidney isn't a blood-type match for the recipient, I believe you can do the transplant with a splenectomy and plasmapheresis to eliminate pools of immune cells and desensitize the immune response to the incompatibility, but I believe that splenectomy has largely been replaced by treatment with rituximab (antibody-drug that targets immune B cells). Perhaps the combination of congenital vascular issues plus incompatibility in this patient made the transplant + splenectomy approach preferable?

Very short summary of another Italian article [1]:

The child is 6. She's needed dialysis since she was born. She never drank water, to prevent problems.

There was an unsuccessful transplant in 2014, because of the immune response.

They couldn't risk another transplant using the blood vessels of the kidneys. She was also at risk of not being able to keep doing dialysis because of the problems to those blood vessels. Because of all of that, they decided to remove the spleen and use its blood vessels for the new kidney. She urinates normally now and she can drink water.

I couldn't find information about the issues with the blood-type mismatch.

[1] http://torino.repubblica.it/cronaca/2016/12/14/news/torino_t...

Also only a lay-person, but my thinking is that since the spleen is similar in function to the kidney, the "splenetic tissue" that remained provided a satisfactory way to "plug" the new kidney into the circulatory system, which would otherwise be far more complex without detaching an existing kidney too.

edit: the Italian news story linked elsewhere on this page does indeed provide more info, and talks about unsuccessful kidney transplants due to "vascular malformation". So yeah, sounds like this was an alternative way to tap into the circulatory system.

The spleen is a lymphatic organ (full of white blood cells), the kidney is a mechanical filter coupled with molecular transport to pick back the good stuff and the water from the filtrated serum.

Beside being solid organs with a roundish shape, they have nothing in common.

Kidneys are usually grafted in the pelvis, using IIRC the iliac vessels, because it is more convenient and allows to keep the existing kidneys that may have some residual function. Maybe that kid had malformed iliac vessels as well...

The spleen is not necessary for life, it is part of your immune system. You can remove it but you are at higher risk for infections, especially certain bacteria. We mitigate this risk by vaccinating against some of these.

Basically, as another poster indicated. The spleen was removed to make room for the kidney, which is what she really needed.

Edit: From what I've read what makes this newsworthy is that they implanted the kidney into the splenic vasculature.

The title of this is very misleading.

They didn't replace spleen function with kidney tissue. They used the vacant place left behind by a removed spleen to place a kidney.

Not just the place, but the fact that a spleen has the hookup for filtering blood.

It's a medical/surgical hack; like relocating a component on a circuit board without re-routing anything, while ensuring it has power and all the right signals.

Well, the spleen is not needed and the kidney could "easily" be attached in place there

But of course things are not too easy and I see two problems: mechanical support and ureter connections

Intentional.

Both kidney and spleen filter blood, although spleen is not essential and can be removed (splenectomy). Sacrificing the spleen, the surgeon used the spleen vessels to connect the kidney to the blood circulation. Reading the Italian news, the vessels of the other kidneys were in bad shape.

Does that mean that we could implant a third kidney to people in the future?

Since the transplant recipient requires immunosuppression anyway it's probably a good trade off.

This is incredible.

To be clear: this was intentional.

Should there be a renaming here?

It's not intentional clickbait, but my brain did catch that title very quickly and proceded as fast as it can to make assumptions.

Both titles here[1] are better in my opinion.

[1]: https://news.ycombinator.com/item?id=13176066

I happened to have absolutely zero doubt about this (i.e. I read/understood it correctly when seeing it on the front page), and I'd just like to take this to point out what an example this is of how great HN is, our culture here, informative and newsworthy, serious things, etc. On any other site (e.g. Reddit) the title (which currently reads "Girl Gets Kidney In Place Of Spleen") would have been some clickbaity shock story to drum up outrage (i.e. it would have been about a single, dramatic case of medical malpractice) , and the comments would have not been intelligent or thoughtful, because the whole story is a throwaway one. Here a story like that would have been buried, and the one we are reading (which would not have made the front page of Reddit) is extremely interesting!

On the other hand, a story about medical malpractice would also be thoughtful, perhaps long-form, heavy on statistivs, etc. Not a single "tabloid story."

(I can see how others here misread the title, I am just pointing out that the only reason those of us who happened to read it correctly did so, is the kind of submissions we have here and which the mods don't bury.)

I think a title change is fine - perhaps it could be changed to "In World First, Girl Gets Kidney In Place Of Spleen"

I immediately thought it was

Because this girl survived

Being in Italy, just by reading the title there was 50/50 chance that it wasn't.

quite racist

That's not racist. Italy is not a race. It is an indictment of the medical competency in Italy based on his perception of their system. I wish people would stop throwing that term around so loosely. If you don't like what he said, then actually form a coherent rebuttal. Not that his comment was much better than your own... just making a point here.

I find it interesting to read that "Foo is not a race." I thought it was pretty established that "race" is a dodgy thing, at best. Such that any collection of people that have been together for a long time would ultimately qualify.

Back to the readings for me, it seems.

You could consider "Italian" to be a race; but Italy is just the country where Italians happen to be from.

I think every person reading malpractice is huge in Italy, took that as Italians are huge in malpractice...

And, I still see race as a dodgy concept.

If Italian is not a race, it surely is a tribal identity that transcends the borders of Italy the country.

As an Italian whose wife is working in the public health care system my views might be a little biased.

Not that Italian system does not have its problems, but we have quite high life expectancy [1] and our system was ranked second in 2000 by the WHO [2] and apparently is still quite efficient [3].

And, by the way, it cures just anybody the same, from super rich people to illegal aliens.

[1] https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

[2] https://en.wikipedia.org/wiki/World_Health_Organization_rank...

[3] https://www.bloomberg.com/news/articles/2016-09-29/u-s-healt...

Just to play devil's advocate though, there are many factors that influence life expectancy outside of the medical system.

Italy seems to have a large confluence of positive factors: 1st world country, relatively healthy traditional diet with fresh fruits, vegetables, and seafood, mild Mediterranean climate, and a culture that emphasizes close familial and social ties.

Of course this is true. Indeed I was not surprised to see the high life expectancy, but more to see the efficiency of the system close to Japan and Israel ones.

I was not making any claims of the Italian medical system. I have no idea how they stack up. I was taking objection to the parent post claiming that the grandparent post was making a racist statement. If you guys are doing great in Italy, then awesome! :) Maybe you guys could share some notes with the United States, particularly when it comes to cost... we need serious help.

I totally agree with you. I'm not the best person to ask for advices, but this guy [1] knows tons about how to run hospitals on budget. The only problem is that he is perceived as very leftish in Europe, so I guess that in the U.S. his opinions will never ever be acceptable.

[1] https://en.wikipedia.org/wiki/Gino_Strada

I am italian... it's not racist... the italian news if filled with malpractice and a title like that wouldn't look out of place, sadly.

EDIT: and just to be specific, it's the news the problem more than the actual sanitary system. Which does have flaws, but is painted way worse than it actually is.

No one writes headlines like "man undergoes surgery, everything ok" unless it's someone really famous. So yeah, you get headlines about malpractice, but I found the remark to be kind of cheap snark.

Italy's health care system is actually pretty decent. Source living in Italy many years.

No of course not, but that doesn't mean that the news should milk everything that goes bad, which creates a distorted perspective.

Italian here. Health malpractice is everywhere, it's just that the Italian media often pick up stories of malpractice because they sell better. Malpractice is usually properly fined and punished. The real malpractice is in how the national healthcare system is managed, at a political and financial level.

http://www.overcomingbias.com/2016/11/careful-who-you-call-r...

Being in Italy, just by reading your post there was 50/50 change that you're a dick, or just misinformed (maybe both).

Please don't. Nothing good (and much bad) can come of it.

We detached this subthread from https://news.ycombinator.com/item?id=13176368 and marked it off-topic.

your leg bone's connected to your........ hip bone

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