To the Editor.—Peters et al1 reported that pretransplant splenectomy is associated with a threefold increase in posttransplant fatal infection. Their report was based on 191 patients having transplants between 1970 and 1981. Of these, 90 (47%) underwent pretransplant splenectomies. Thirty-two of 90 asplenic patients died of sepsis, compared with ten of 101 patients who had not undergone splenectomies.
I suggest an alternative interpretation of their findings. The authors report that from 1970 to 1974 only four of 75 patients did not undergo a pretransplant bilateral nephrectomy, splenectomy, and appendectomy. Thus, 71 of their 90 asplenic transplant recipients received their grafts between 1970 and 1974. Ninety-seven of the 101 patients not undergoing a splenectomy had transplants between 1975 and 1981.
During the decade between 1970 and 1980, transplant centers across the United States reported significant changes in their immunosuppressive protocols, leading to lowered total immunosuppression, a decreased infection rate,