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Comment by noobermin | Hacker News Reader

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

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.

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...

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

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