Splenic immunological Function after Trauma - SIFAT Trial

The spleen plays a key role in immune surveillance, and splenectomy after trauma is associated with long-term immunological impairment. While spleen-preserving strategies such as non-operative management (NOM) and splenic artery embolization (SAE) are increasingly adopted, their impact on residual immune function remains incompletely defined. This study evaluated post-traumatic immune recovery using a multimodal approach integrating virological, immunological, cellular, and imaging-based parameters. Adult patients with blunt splenic injury managed with operative management (OM), angioembolization (ANGIO), or NOM were prospectively enrolled, together with a control group. Immune function was longitudinally assessed using Torque Teno Virus (TTV) viral load, QuantiFERON-CMV, lymphocyte subpopulation analysis, and CT-based splenic volumetry. All trauma patients showed transient immune suppression in the acute phase, with elevated TTV levels and reduced QuantiFERON responses. At three months, immune recovery was observed across groups, with the most pronounced improvement in ANGIO patients, characterized by declining TTV load and increased interferon-γ production. Lymphocyte subpopulation dynamics were comparable between ANGIO and NOM patients, with preservation of major T-cell, B-cell, and NK-cell subsets. CT volumetry revealed divergent but non-significant trends in splenic volume, without evidence of clinically relevant functional impairment. These findings suggest that SAE preserves splenic immune function in the medium term, with immunological outcomes comparable to NOM and distinct from splenectomy. Multimodal immune monitoring may provide a valuable framework for individualized post-trauma management.