In Reply.—We reviewed 191 recipients of single renal allografts. Pretransplant splenectomy, performed in 90 cases, was accompanied by 32 infection-caused deaths and 12 deaths unrelated to infection following transplantation. Ten fatal infections and 14 deaths not related to infection occurred among the 101 spleen-retaining patients. Our intent was to report this single-center experience and to emphasize that individual centers should evaluate their own practices. Sutherland and colleagues seem to draw conclusions from our article that we did not advance or intend to make. We drew no conclusions regarding graft survival rates or risk for infection. Furthermore, we did not equate "the incidence of death by sepsis" with infection-caused mortality, but did report the number of patients who died of polymicrobial or single-organism illnesses, and of sepsis or confined (eg, meningitis) infection.
The correspondents are correct in suspecting that patients having transplants earlier in the series were weighted to splenectomy