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González-Ramos L, Mora-Cuesta VM, Iturbe-Fernández D, Tello-Mena S, Sánchez-Moreno L, Andia-Torrico D, Alonso-Lecue P, Ballesteros-Sanz MDLÁ, Naranjo-Gozalo S, Cifrián-Martínez JM. Early Postoperative Outcomes of Lung Transplant Recipients With Abdominal Adverse Events. Transplant Proc 2023; 55:459-465. [PMID: 37059668 DOI: 10.1016/j.transproceed.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/03/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Patients undergoing lung transplantation (LT) are at high risk of developing serious abdominal complications, which can lead to higher rates of morbidity and mortality. The aim of this study was to investigate the incidence and spectrum of these complications when they develop during the first 30 days after LT, as well as their possible association with possible risk factors. METHODS A retrospective study of 552 patients undergoing LT between 01/02/2006 and 06/03/2021 was carried out. A descriptive and analytical evaluation of the patients who experienced complications and those who did not was performed comparatively. Data related to patient characteristics and the lung transplantation procedure were collected. RESULTS Overall, 8.2% of patients developed severe abdominal complications during the first 30 days; paralytic ileus was the most frequent (31.1%), closely followed by visceral perforation (26.7%). The percentage of patients who required an invasive procedure to manage post-transplant complications was 57.8%. Surgical intervention was required in 39.8%. The variables that showed a significant relationship with the development of severe short-term abdominal complications in the univariate analysis were the time of surgery, the use of ECMO/ ECC and red blood cell transfusion during or after surgery. In the multivariate study, however, only duration of surgery remained significant (p=0.03). CONCLUSION The incidence of severe short-term abdominal complications after LT period was 8%. The commonest complications were paralytic ileus and intestinal perforation. Most patients did not require surgery. The only risk factor found associated with these complications was the duration of the surgical intervention.
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Affiliation(s)
- Laura González-Ramos
- Marqués de Valdecilla University Hospital, Respiratory Department, Santander, Spain
| | | | | | - Sandra Tello-Mena
- Marqués de Valdecilla University Hospital, Respiratory Department, Santander, Spain
| | | | | | | | | | - Sara Naranjo-Gozalo
- Marqués de Valdecilla University Hospital, Thoracic Surgery, Santander, Spain
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Abstract
The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.
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Martínez-Chamorro E, Ibáñez L, Navallas M, Navas I, Cambra F, Gónzalez-Serrano M, Borruel S. Acute cholecystitis in recent lung transplant patients: a single-institution series of 10 cases. Abdom Radiol (NY) 2021; 46:3855-3865. [PMID: 33745020 DOI: 10.1007/s00261-021-03039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the clinical and imaging findings of acute cholecystitis in recent lung transplant patients. METHODS We retrospectively reviewed all abdominal ultrasounds and computed tomography (CT) scans of patients who developed acute cholecystitis in the early postoperative period following lung transplantation from November 2014 to December 2020 in a tertiary care university hospital. RESULTS Ten patients (4.4%) were included in this series (6 male, mean age 62.9 years ± 2.1 [standard deviation]) of a total 227 lung transplant patients performed from November 2014 to December 2020 (172 unilateral and 55 bilateral). Nine (90%) patients received a double-lung transplant and seven (70%) required extracorporeal circulation during surgery. Acute cholecystitis occurred during the initial admission for lung transplantation (average of 33 ± 25.9 days post-transplantation). Six patients (60%) died during admission with an average of 24.3 ± 21.8 days after cholecystectomy. The most frequent imaging findings were gallbladder wall discontinuity or decreased gallbladder mural enhancement (100%, 10 patients) and gallbladder distension (90%, 9 patients). All acute cholecystitis were found to be ischemic / gangrenous at surgery and/or pathology, 40% (4 patients) were hemorrhagic and 30% (3 patients) were perforated, one of them with a cholecystoduodenal fistula. Fungal cholecystitis was demonstrated at histological exam in one patient. CONCLUSION Acute cholecystitis in the early postoperative period after lung transplantation is an important cause of morbidity and mortality. Ischemic or gangrenous cholecystitis prevails. The key imaging findings are parietal perfusion defects and gallbladder distension, which can easily go unnoticed if not specifically looked for.
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Affiliation(s)
- Elena Martínez-Chamorro
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain.
| | - Laín Ibáñez
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - María Navallas
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Irene Navas
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Félix Cambra
- Department of General Surgery, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Matilde Gónzalez-Serrano
- Department of Anesthesiology, Transplant Unit, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Susana Borruel
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
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Olson MT, Elnahas S, Dameworth J, Row D, Gagliano RA, Roy SB, Kang P, Walia R, Bremner RM. Management and Outcomes of Diverticulitis After Lung Transplantation. Prog Transplant 2020; 30:235-242. [PMID: 32583709 DOI: 10.1177/1526924820933830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Most lung transplant patients are older than 50 years. Complications from colonic diverticula are not uncommon, especially with chronic immunosuppression. However, limited data exist regarding the optimal management of these patients. We sought to investigate the incidence, risk factors, and outcomes of diverticulitis after lung transplant. METHODS We conducted a retrospective study to review patients undergoing lung transplant between 2007 and 2016 with posttransplant acute colonic diverticulitis. Patients were grouped based on medical or surgical management. RESULTS Of 512 transplant recipients, 17 (3.32%) developed 26 episodes of diverticulitis over a median follow-up of 39 months. Nine patients had documented diverticulosis on pretransplant colonoscopy. These patients had a higher incidence of surgical intervention for diverticulitis, were more likely to have recurrent diverticulitis, and had longer lengths of stay than patients without pretransplant diverticulosis. Six (35.3%) of 17 patients required surgery (ie, Hartmann procedure; 4 during the initial episode and 2 during their third and fourth episodes); 11 patients (64.7%) were managed with antibiotics alone. Patients in the surgical group presented earlier posttransplant (P = .004) and were on higher doses of tacrolimus (P = .03). Six (46.1%) of 13 patients with medically managed first episodes of diverticulitis experienced recurrence. No recurrence occurred after surgical management. No deaths were attributable to diverticulitis in either group. CONCLUSIONS Patients with pretransplant diverticulosis experienced earlier, more complicated episodes of diverticulitis posttransplant than patients without. Surgical patients received higher doses of tacrolimus and presented earlier than medical patients. Uncomplicated diverticulitis in posttransplant patients can be managed medically, even in the case of recurrent, uncomplicated disease.
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Affiliation(s)
- Michael T Olson
- University of Arizona College of Medicine, Phoenix, AZ, USA.,Norton Thoracic Institute, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Shaimaa Elnahas
- Norton Thoracic Institute, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jonathan Dameworth
- Department of Surgery, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - David Row
- Department of Surgery, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ronald A Gagliano
- Department of Surgery, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sreeja Biswas Roy
- Department of Internal Medicine, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Paul Kang
- Norton Thoracic Institute, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rajat Walia
- Norton Thoracic Institute, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ross M Bremner
- Norton Thoracic Institute, 6586St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Dako F, Hota P, Kahn M, Kumaran M, Agosto O. Post-lung transplantation abdominopelvic complications: the role of multimodal imaging. Abdom Radiol (NY) 2020; 45:1202-1213. [PMID: 31552464 DOI: 10.1007/s00261-019-02229-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung transplantation (LT) is an established method for treating end-stage lung disease. Although most of the post-lung transplant imaging surveillance is focused on chronic lung allograft rejection, abdominopelvic complications have been reported in 7-62% of patients. The reported wide range of post-LT abdominopelvic complications is thought to be secondary to lack of current standardized definitions. These complications encompass a heterogeneous group of disorders including upper and lower gastrointestinal (GI) disorders, inflammatory conditions of solid organs, lymphoproliferative disorders, and neoplasms; each with varying pathophysiology, timing, severity, and treatment. Clinical manifestations of these complications may overlap or be masked by immunosuppression; therefore, imaging plays a paramount role in the early management and treatment.
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Affiliation(s)
- Farouk Dako
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA.
| | - Partha Hota
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mansoor Kahn
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
| | - Maruti Kumaran
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
| | - Omar Agosto
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
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Zevallos-Villegas A, Alonso-Moralejo R, Cambra F, Hermida-Anchuelo A, Pérez-González V, Gámez-García P, Sayas-Catalán J, De Pablo-Gafas A. Morbidity and mortality of serious gastrointestinal complications after lung transplantation. J Cardiothorac Surg 2019; 14:181. [PMID: 31661002 PMCID: PMC6819340 DOI: 10.1186/s13019-019-0983-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. METHODS We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. RESULTS There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). CONCLUSIONS SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.
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Affiliation(s)
- Annette Zevallos-Villegas
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain.
| | - Rodrigo Alonso-Moralejo
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Félix Cambra
- Department of General and Digestive Surgery, "12 de Octubre" University Hospital, Madrid, Spain
| | - Ana Hermida-Anchuelo
- Department of Anesthesiology, Lung Transplant Unit, "12 de Octubre" University Hospital, Madrid, Spain
| | - Virginia Pérez-González
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Pablo Gámez-García
- Department of Thoracic Surgery, Lung Transplant Unit, "12 de Octubre" University Hospital, Madrid, Spain
| | - Javier Sayas-Catalán
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Alicia De Pablo-Gafas
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
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Sulser P, Lehmann K, Schuurmans MM, Weder W, Inci I. Early and late abdominal surgeries after lung transplantation: incidence and outcome. Interact Cardiovasc Thorac Surg 2019; 27:727-732. [PMID: 29846608 DOI: 10.1093/icvts/ivy172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/24/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Abdominal surgery after lung transplantation is an important factor for major morbidity and mortality. Herein, we describe the incidence and outcome of abdominal surgery occurring early or late after transplantation. METHODS Overall, 315 patients who underwent lung transplantation between January 2000 and December 2013 at our institution were included in a prospective database. Perioperative parameters were assessed, and complications were graded according to the Clavien-Dindo Classification. RESULTS Among 315 patients after lung transplantation, 52 patients underwent abdominal surgery, 16 during the early postoperative phase and 42 at later time points. Bowel ischaemia and perforation of the right colon were the most common reason for early surgery, with a median interval of 7 days after lung transplantation. The median survival time for patients with early abdominal surgery was 31 months compared to 40 and 90 months for patients with no or late abdominal surgery (P = 0.001 and P = 0.002, respectively). The most common late indications for surgery were perforated diverticulitis, ileus and hernia, with a median interval of 37.9 months after lung transplantation and a median survival comparable with patients without any abdominal surgery (P = 0.9). However, prior hospitalization due to a non-abdominal disease was associated with increased morbidity (P = 0.006) after late surgery. CONCLUSIONS Early abdominal surgeries after lung transplantation are associated with a significant mortality risk. Abdominal operations at late time points have a favourable outcome unless patients were hospitalized prior to the abdominal complication. Clinical trial registration number ZH-KEK-Nr. 2014-0244.
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Affiliation(s)
- Pascale Sulser
- Department Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kuno Lehmann
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Department Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Spratt JR, Brown RZ, Rudser K, Goswami U, Hertz MI, Patil J, Cich I, Shumway SJ, Loor G. Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:1130-1144. [PMID: 31179055 DOI: 10.21037/jtd.2019.04.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Alpha-1-antitrypsin (A1AT) deficiency (A1ATD) is characterized by accelerated degradation of lung function. We examined our experience with lung transplantation for chronic obstructive pulmonary disease (COPD) with and without A1ATD to compare survival and rates of postoperative surgical complications. Methods Patients with A1ATD and non-A1ATD COPD undergoing lung transplantation from 1988-2015 at our institution were analyzed. Complications were categorized into non-gastroenteritis gastrointestinal (GI), wound, airway, and reoperation for bleeding. Overall and complication-free survival were evaluated using Kaplan-Meier curves and Cox proportional hazards models. Results Three hundred and eighty-five patients underwent lung transplant for COPD (98 A1ATD). For A1ATD, 56.1% underwent single lung transplantation (80.6% for COPD). Early overall and complication-free survival was worse for A1ATD, but this trend reversed at longer follow up. Unadjusted estimated survival showed advantage for COPD at 90 days and 1 year, which attenuated by 5 years and reversed at 10 years (P<0.001). On adjusted analysis, A1ATD was associated with a trend toward lower complication-free survival at 90 days and 1 year, due partly to increased rates of post-transplant GI pathology, particularly in the era of the lung allocation score (LAS). Conclusions A1ATD lung recipients had worse short-term complication-free survival but improved long-term survival compared to COPD patients. A1ATD was associated with greater risk of new GI pathology after transplant. Close monitoring of A1ATD patients with timely evaluation of GI complaints after transplant is warranted.
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Affiliation(s)
- John R Spratt
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Roland Z Brown
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Umesh Goswami
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Marshall I Hertz
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jagadish Patil
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Irena Cich
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Sara J Shumway
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Gabriel Loor
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Infections in Heart, Lung, and Heart-Lung Transplantation. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7121494 DOI: 10.1007/978-1-4939-9034-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Half a century has passed since the first orthotopic heart transplant took place. Surgical innovations allowed for heart, lung, and heart-lung transplantation to save lives of patients with incurable chronic cardiopulmonary conditions. The complexity of the surgical interventions, chronic host health conditions, and antirejection immunosuppressive medications makes infectious complications common. Infections have remained one of the main barriers for successful transplantation and a source of significant morbidity and mortality. Recognition of infections and its management in this setting require outstanding clinical skills since transplant recipients may not exhibit classic signs or symptoms of disease, and laboratory work has some pitfalls. The prevention, identification, and management of infectious diseases complications in this population are a priority to undertake to improve the medical outcomes of transplantation. Herein, we reviewed the historical aspects, epidemiology, and prophylaxis of infections in heart, lung, and heart-lung transplantation. We also discuss the most prevalent organisms affecting the host and the organ systems involved.
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10
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Outcomes Following Colorectal Resection in Kidney Transplant Recipients. J Gastrointest Surg 2018; 22:1603-1610. [PMID: 29736667 PMCID: PMC6222018 DOI: 10.1007/s11605-018-3801-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Kidney transplant recipients (KTR) are at increased risk of requiring colorectal resection compared to the general population. Given the need for lifelong immunosuppression and the physiologic impact of years of renal replacement, we hypothesized that colorectal resection may be riskier for this unique population. METHODS We investigated the differences in mortality, morbidity, length of stay (LOS), and cost between 2410 KTR and 1,433,437 non-KTR undergoing colorectal resection at both transplant and non-transplant centers using the National Inpatient Sample between 2000 and 2013, adjusting for patient and hospital level factors. RESULTS In hospital, mortality was higher for KTR in comparison to non-KTR (11.1 vs 4.3%, p < 0.001; adjusted odds ratio [aOR] 2.683.594.81) as were overall complications (38.5 vs 31.5%, p = 0.001; aOR 1.081.301.56). LOS was significantly longer (10 vs 7 days, p < 0.001; ratio 1.421.531.65) and cost was significantly greater ($23,056 vs $14,139, p < 0.001; ratio 1.421.541.63) for KTR compared to non-KTR. While LOS was longer for KTR undergoing resection at transplant centers compared to non-transplant centers (aOR 1.68 vs 1.53, p = 0.03), there were no statistically significant differences in mortality, overall morbidity, or cost by center type. CONCLUSIONS KTR have higher mortality, higher incidence of overall complications, longer LOS, and higher cost than non-KTR following colorectal resection, regardless of center type. Physicians should consider these elevated risks when planning for surgery in the KTR population and counsel patients accordingly.
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11
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Kayawake H, Chen-Yoshikawa TF, Motoyama H, Hamaji M, Nakajima D, Aoyama A, Date H. Gastrointestinal complications after lung transplantation in Japanese patients. Surg Today 2018; 48:883-890. [PMID: 29713813 DOI: 10.1007/s00595-018-1666-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/13/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Gastrointestinal complications after lung transplantation (LTx) are an important postoperative morbidity associated with malnutrition and the malabsorption of drugs. We reviewed our experience of managing gastrointestinal complications after LTx. METHODS Between June, 2008 and April, 2017, 160 lung transplants were performed at our institution, as living-donor lobar lung transplants in 77 patients, and as deceased-donor lung transplants in 83. We reviewed, retrospectively, the incidence, type and management of gastrointestinal complications. RESULTS Among the 160 LTx recipients, 58 (36.3%) suffered a collective 70 gastrointestinal complications, the most frequent being gastroparesis, followed by gastroesophageal reflux disease. Two complications were managed surgically, by Nissen fundoplication for gastroesophageal reflux disease in one recipient and Hartmann's operation for sigmoid colon perforation in one. The other 68 complications were managed medically. Two patients died of complications: one, of aspiration pneumonia caused by gastroparesis; and one, of panperitonitis caused by a gastric ulcer. There were no significant differences in overall survival or chronic lung allograft dysfunction-free survival between the patients with and those without gastrointestinal complications. CONCLUSIONS Gastrointestinal complications are not uncommon in LTx recipients and may be serious; therefore, early detection and appropriate treatment are imperative. Surgical management is required for some complications, but most can be managed medically.
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Affiliation(s)
- Hidenao Kayawake
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hideki Motoyama
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Costa HF, Malvezzi Messias P, dos Reis FP, Gomes-Junior O, Fernandes LM, Abdalla LG, Campos SV, Teixeira RHOB, Samano MN, Pêgo-Fernandes PM. Abdominal Complications After Lung Transplantation in a Brazilian Single Center. Transplant Proc 2018; 49:878-881. [PMID: 28457416 DOI: 10.1016/j.transproceed.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Surgical and nonsurgical abdominal complications have been described after lung transplantation. However, there is limited data on this event in this population. The objective of this study was to analyze the incidence of abdominal complications in patients undergoing lung transplantation at the Heart Institute of the Faculty of Medicine, University of São Paulo (InCor-HCFMUSP) between the years 2003 and 2016. The main causes of abdominal complications were inflammatory acute abdomen (7 patients; 14%), obstructive acute abdomen (9 patients; 18%), gastroparesis (4 patients; 8%), distal intestinal obstruction syndrome (4 patients; 8%), perforated acute abdomen (7 patients; 14%), cytomegalovirus (CMV; 6 patients; 12%), and other reasons (12 patients; 26%). Separating these patients according to Clavien-Dindo classification, we had 21 patients (43%) with complications grade II, 4 patients (8%) with complications grade IIIa, 7 patients (14%) with grade IIIb complications, 7 patients (14%) with grade IV complications, and 10 patients (21%) with grade complications V. In conclusion, abdominal disorders are seriously increased after lung transplantation and correlate with a high mortality. Early abdominal surgical complication has worse prognosis.
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Affiliation(s)
- H F Costa
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - F P dos Reis
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - O Gomes-Junior
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L M Fernandes
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L G Abdalla
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S V Campos
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - R H O B Teixeira
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M N Samano
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - P M Pêgo-Fernandes
- Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Abraham JM, Taylor CJ. Cystic Fibrosis & disorders of the large intestine: DIOS, constipation, and colorectal cancer. J Cyst Fibros 2017; 16 Suppl 2:S40-S49. [DOI: 10.1016/j.jcf.2017.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 01/04/2023]
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Heinrich H, Neuenschwander A, Russmann S, Misselwitz B, Benden C, Schuurmans MM. Prevalence of gastrointestinal dysmotility and complications detected by abdominal plain films after lung transplantation: a single-centre cohort study. BMJ Open Respir Res 2016; 3:e000162. [PMID: 28090331 PMCID: PMC5223726 DOI: 10.1136/bmjresp-2016-000162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/18/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction and Aims Gastrointestinal (GI) complications such as gastric retention (GR) and constipation are common after lung transplantation (LT). Abdominal plain films (APFs) are a low-cost diagnostic tool to detect impaired GI function. The goal of our study was to assess the prevalence of GI pathology seen on APF in lung transplant recipients (LTRs) and to identify associated risk factors. Methods Retrospective analysis of consecutive LTRs followed up between 2001 and 2013. Demographic, radiographic and clinical data were assessed. Results 198 patients were included in the study, 166 thereof had more than 1 APF with a mean number of 5 APFs per patient. 163 patients had a detectable radiographic pathology on APF. The proportion of LTR with GR was highest among cystic fibrosis patients (48.5%). Multivariate regression analysis showed a significant association of diabetes with GR with a trend for age and use of opiates as risk factors. Similarly, female sex, advanced age and diabetes showed a trend to be associated with lower GI tract complications. Almost all patients had suffered from at least 1 episode of lower GI dysmotility during a median follow-up of 5.7 years. No clear correlation between GI events and the development of chronic lung allograft dysfunction could be identified. Conclusions We found a statistically significant association of diabetes with GR and a progressive increase in the prevalence of GR over time after LT. Lower GI complications affected >80% of LTR and increased over time. Future studies correlating GI transit with APF findings are needed.
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Affiliation(s)
- Henriette Heinrich
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Anne Neuenschwander
- Division of Pulmonary Medicine , University Hospital Zurich , Zurich , Switzerland
| | - Stefan Russmann
- Division of Clinical Pharmacology and Toxicology , University Hospital Zurich , Zurich , Switzerland
| | - Benjamin Misselwitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonary Medicine , University Hospital Zurich , Zurich , Switzerland
| | - Macé M Schuurmans
- Division of Pulmonary Medicine , University Hospital Zurich , Zurich , Switzerland
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de'Angelis N, Esposito F, Memeo R, Lizzi V, Martìnez-Pérez A, Landi F, Genova P, Catena F, Brunetti F, Azoulay D. Emergency abdominal surgery after solid organ transplantation: a systematic review. World J Emerg Surg 2016; 11:43. [PMID: 27582783 PMCID: PMC5006611 DOI: 10.1186/s13017-016-0101-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/17/2016] [Indexed: 02/07/2023] Open
Abstract
AIMS Due to the increasing number of solid organs transplantations, emergency abdominal surgery in transplanted patients is becoming a relevant challenge for the general surgeon. The aim of this systematic review of the literature is to analyze morbidity and mortality of emergency abdominal surgery performed in transplanted patients for graft-unrelated surgical problems. METHODS The literature search was performed on online databases with the time limit 1990-2015. Studies describing all types of emergency abdominal surgery in solid organ transplanted patients were retrieved for evaluation. RESULTS Thirty-nine case series published between 1996 and 2015 met the inclusion criteria and were selected for the systematic review. Overall, they included 71671 transplanted patients, of which 1761 (2.5 %) underwent emergency abdominal surgery. The transplanted organs were the heart in 65.8 % of patients, the lung in 22.1 %, the kidney in 9.5 %, and the liver in 2.6 %. The mean patients' age at the time of the emergency abdominal surgery was 49.4 ± 7.4 years, and the median time from transplantation to emergency surgery was 2.4 years (range 0.1-20). Indications for emergency abdominal surgery were: gallbladder diseases (80.3 %), gastrointestinal perforations (9.2 %), complicated diverticulitis (6.2 %), small bowel obstructions (2 %), and appendicitis (2 %). The overall mortality was 5.5 % (range 0-17.5 %). The morbidity rate varied from 13.6 % for gallbladder diseases to 32.7 % for complicated diverticulitis. Most of the time, the immunosuppressive therapy was maintained unmodified postoperatively. CONCLUSIONS Emergency abdominal surgery in transplanted patients is not a rare event. Although associated with relevant mortality and morbidity, a prompt and appropriate surgery can lead to satisfactory results if performed taking into account the patient's immunosuppression therapy and hemodynamic stability.
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Affiliation(s)
- Nicola de'Angelis
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Francesco Esposito
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Riccardo Memeo
- Department of Hepato-biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Strasbourg, France
| | - Vincenzo Lizzi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Aleix Martìnez-Pérez
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Filippo Landi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Pietro Genova
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Fausto Catena
- Department of Emergency Surgery, University Hospital "Ospedale Maggiore" of Parma, Parma, Italy
| | - Francesco Brunetti
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Daniel Azoulay
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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16
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Grass F, Schäfer M, Cristaudi A, Berutto C, Aubert JD, Gonzalez M, Demartines N, Ris HB, Soccal PM, Krueger T. Incidence and Risk Factors of Abdominal Complications After Lung Transplantation. World J Surg 2016; 39:2274-81. [PMID: 26013207 DOI: 10.1007/s00268-015-3098-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Due to the underlying diseases and the need for immunosuppression, patients after lung transplantation are particularly at risk for gastrointestinal (GI) complications that may negatively influence long-term outcome. The present study assessed the incidences and impact of GI complications after lung transplantation and aimed to identify risk factors. METHODS Retrospective analysis of all 227 consecutively performed single- and double-lung transplantations at the University hospitals of Lausanne and Geneva was performed between January 1993 and December 2010. Logistic regressions were used to test the effect of potentially influencing variables on the binary outcomes overall, severe, and surgery-requiring complications, followed by a multiple logistic regression model. RESULTS Final analysis included 205 patients for the purpose of the present study, and 22 patients were excluded due to re-transplantation, multiorgan transplantation, or incomplete datasets. GI complications were observed in 127 patients (62%). Gastro-esophageal reflux disease was the most commonly observed complication (22.9%), followed by inflammatory or infectious colitis (20.5%) and gastroparesis (10.7%). Major GI complications (Dindo/Clavien III-V) were observed in 83 (40.5%) patients and were fatal in 4 patients (2.0%). Multivariate analysis identified double-lung transplantation (p = 0.012) and early (1993-1998) transplantation period (p = 0.008) as independent risk factors for developing major GI complications. Forty-three (21%) patients required surgery such as colectomy, cholecystectomy, and fundoplication in 6.8, 6.3, and 3.9% of the patients, respectively. Multivariate analysis identified Charlson comorbidity index of ≥3 as an independent risk factor for developing GI complications requiring surgery (p = 0.015). CONCLUSION GI complications after lung transplantation are common. Outcome was rather encouraging in the setting of our transplant center.
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Affiliation(s)
- Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, 1011, Lausanne, Switzerland,
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Postoperative outcomes with cholecystectomy in lung transplant recipients. Surgery 2015; 158:373-8. [PMID: 25999250 DOI: 10.1016/j.surg.2015.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 02/21/2015] [Accepted: 02/28/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION There is a paucity of data on outcomes for lung transplant (LT) recipients requiring general surgery procedures. This study examined outcomes after cholecystectomy in LT recipients using a large database. METHODS The National Inpatient Sample Database (2005-2010) was queried for all LT patients requiring laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). RESULTS There were a total of 377 cholecystectomies performed in LT patients. The majority were done for acute cholecystitis (n = 218; 57%) and were done urgently/emergently (n = 258; 68%). There were a total of 304 (81%) laparoscopic cholecystectomies and 73 (19%) OC. There was no difference in age when comparing the laparoscopic and open groups (53.6 vs 55.5 years; P = .39). In addition, the Charlson Comorbidity Index was similar in the 2 groups (P = .07). Patients undergoing OC were more likely to have perioperative myocardial infarction, pulmonary embolus, or any complication compared with the laparoscopic group. Total hospital charges ($59,137.00 vs $106,329.80; P = .03) and median duration of stay (4.0 vs 8.0 days; P = .02) were both greater with open compared with LC. CONCLUSION Cholecystectomy can be performed safely in the LT population with minimal morbidity and mortality.
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Larson ES, Khalil HA, Lin AY, Russell M, Ardehali A, Ross D, Yoo J. Diverticulitis occurs early after lung transplantation. J Surg Res 2014; 190:667-71. [PMID: 24912859 DOI: 10.1016/j.jss.2014.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/23/2014] [Accepted: 05/05/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Lung transplantation recipients are at an increased risk for developing diverticulitis. However, the incidence and natural history of diverticulitis have not been well characterized. Our objective was to identify patient and transplant-related factors that may be associated with an increased risk of developing diverticulitis in this patient population. MATERIALS AND METHODS This is a retrospective single institution study. All patients who received a lung transplant between May 2008 and July 2013 were evaluated using an existing lung transplantation database. Patient-related factors, the incidence and timing of diverticulitis, and outcomes of medical and surgical management were measured. RESULTS Of the 314 patients who received a lung transplant, 14 patients (4.5%) developed diverticulitis. All episodes (100%) of diverticulitis occurred within the first 2 y after transplantation. Eight patients (57%) required surgery with a mortality rate of 12.5%. Six patients (43%) were managed medically and did not require surgery with a mean follow-up period of 442 d. CONCLUSIONS Diverticulitis is common after lung transplantation and occurs with a higher incidence compared with the general population. Diverticulitis occurs early in the posttransplant period, and the majority of patients require surgery. Patients who respond promptly to medical treatment may not require elective resection. A greater awareness of the risk of diverticulitis in the early posttransplant period may allow for earlier diagnosis and treatment.
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Affiliation(s)
| | | | - Anne Y Lin
- Department of Surgery, UCLA, Los Angeles, CA
| | | | | | - David Ross
- Department of Medicine, UCLA, Los Angeles, CA
| | - James Yoo
- Department of Surgery, Tufts Medical Center, Boston, MA.
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Seo M, Kim WJ, Choi IC. Anesthesia for non-pulmonary surgical intervention following lung transplantation: two cases report. Korean J Anesthesiol 2014; 66:322-6. [PMID: 24851171 PMCID: PMC4028563 DOI: 10.4097/kjae.2014.66.4.322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/27/2013] [Accepted: 03/31/2013] [Indexed: 11/16/2022] Open
Abstract
The survival rate after lung transplantation has increased in recent years, leading to an increase in non-pulmonary conditions that require surgical intervention. These post-transplant surgical procedures, however, are associated with high mortality and morbidity rates. Intra-abdominal conditions are the most common reasons for surgical intervention. We describe here two patients who underwent abdominal surgery under general anesthesia following lung transplantation. One patient underwent cholecystectomy due to cholecystitis after heart-lung transplantation, and the other patient had an exploratory laparotomy for duodenal ulcer perforation after double lung transplantation. Depending on the type of transplant intervention, the physiology of the transplanted lung must be considered for general anesthesia. Knowledge of underlying conditions and immunosuppressive therapy following transplantation are important for safe and effective general anesthesia.
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Affiliation(s)
- Misook Seo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook Jong Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Bredahl P, Zemtsovski M, Perch M, Pedersen DL, Rasmussen A, Steinbrüchel D, Carlsen J, Iversen M. Early laparotomy after lung transplantation: increased incidence for patients with α1-anti-trypsin deficiency. J Heart Lung Transplant 2014; 33:727-33. [PMID: 24709270 DOI: 10.1016/j.healun.2014.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Gastrointestinal complications after lung transplantation have been reported with incidence rates ranging from 3% to 51%, but the reasons are poorly understood. We aimed to investigate the correlations between pulmonary diseases leading to lung transplantation and early gastrointestinal complications requiring laparotomy after transplantation with outcomes for patients at increased risk. METHODS In this study we performed a retrospective analysis of data of patients who underwent lung transplantation at our institution from 2004 to 2012. The study period was limited to the first 90 days after transplantation. RESULTS Lung transplantation was performed in 258 patients, including 51 patients with α1-anti-trypsin deficiency (A1AD). Seventy-eight patients (30%) had an X-ray of the abdomen, and 23 patients (9%) required laparotomy during the first 90 days after transplantation. Patients with A1AD comprised 20% of the total recipients, 23% (18 of 78) of the patients who had an abdominal X-ray performed (p = 0.40), and 48% (11 of 23) of the patients who required laparotomy (p < 0.001). More than 1 of every 5 patients (11 of 51) with A1AD required laparotomy at a median 8 days after transplantation, and the estimated odds ratio for laparotomy for A1AD patients was 5.74 (CI 2.15 to 15.35). In the group of patients with A1AD who required laparotomy, the estimated hazard ratio for death was 1.62 (CI 0.57 to 4.62), the stay in the intensive care unit was prolonged, but no significant difference was observed for time on mechanical ventilation. Among pulmonary diseases and demographics of the patients, no other risk factors were identified for laparotomy. CONCLUSIONS A1AD was the only significant risk factor identified for gastrointestinal complications that required laparotomy within 3 months after lung transplantation. There was a trend toward a higher risk of death after laparotomy in patients with A1AD, and the length of stay in the intensive care unit was significantly prolonged, whereas the time on mechanical ventilation was unaffected.
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Affiliation(s)
- Pia Bredahl
- Department of Cardiothoracic Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Mikhail Zemtsovski
- Department of Cardiothoracic Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Dorte Levin Pedersen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Division of Liver Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Steinbrüchel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørn Carlsen
- Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Iversen
- Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Prognostic factors in lung transplantation: the Santa Casa de Porto Alegre experience. Transplantation 2011; 91:1297-303. [PMID: 21572382 DOI: 10.1097/tp.0b013e31821ab8e5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung transplantation (LT) has been established as a current therapy for selected patients with end-stage lung disease. Different prognostic factors have been reported by transplant centers. The objective of this study is to report our recent results with LT and to search for prognostic factors. METHODS We performed a retrospective analysis of 130 patients who underwent LT at our institution from January 2004 to July 2009. Donor, recipient, intraoperative, and postoperative variables were collected. RESULTS The mean age was 53.14 years (ranging from 8 to 72 years) and 80 (61.5%) were male. The main causes of end-stage respiratory disease were pulmonary fibrosis 53 (40.7%) and chronic obstructive pulmonary disease 52 (40%). The actuarial 1-year survival was 67.7%. Variables correlated with survival were age (P=0.004), distance in the 6-min walk test (P=0.007), coronary heart disease (P=0.001), cardiopulmonary bypass (P=0.02), intraoperative transfusion of red blood cells (P=0.016), increasing central venous pressure at 24th postoperative hour (P=0.001), increasing pulmonary capillary wedge pressure at 24th postoperative hour (P=0.01); length of intubation (P<0.01), reintubation (P=0.001), length of intensive care unit stay (P<0.001), abdominal complication (P=0.003), acute renal failure requiring dialysis (P<0.001), native lung hyperinflation (P=0.02), and acute rejection in the first month (P=0.03). In multivariate analysis, only dialysis (P=0.004, hazards ratio [HR] 2.68), length of intubation (P=0.004, HR 1.002 for each hour), and reintubation (P=0.003, HR 2.88) proved to be independent predictors. CONCLUSION Analysis of variables in our cohort highlighted dialysis, longer mechanical ventilation requirement, and reintubation as independent prognostic factors in LT.
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Lahon B, Mordant P, Thabut G, Georger JF, Dauriat G, Mal H, Lesèche G, Castier Y. Early severe digestive complications after lung transplantation. Eur J Cardiothorac Surg 2011; 40:1419-24. [PMID: 21497510 DOI: 10.1016/j.ejcts.2011.02.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 02/02/2011] [Accepted: 02/08/2011] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study aimed to describe and to analyze early severe digestive complications (ESDC) after lung transplantation (LT) in our center. METHODS A retrospective study included 351 patients, who underwent LT without cardiopulmonary bypass (CPB) at our center between March 1988 and December 2009. There were 86 double LTs and 265 single LTs. ESDCs were defined as complications (1) occurring during the first 30 days after transplantation or during initial hospitalization if longer; (2) involving the gastrointestinal tract; and (3) jeopardizing survival or requiring invasive therapeutic procedure. Patients' characteristics, associated risk factors, and influence of ESDC on early outcome have been analyzed. RESULTS During the first 30 days after LT or initial hospitalization if longer, 26 ESDCs occurred in 26 patients (rate 7.4%, sex ratio M/F 66%, mean age 56 ± 6 years). This included 10 acute cholecystitis (38%), four angiocholitis (15%), three perforated gastroduodenal ulcers (11%), three digestive perforations (11%), two intestinal occlusions (8%), two mesenteric ischemia (8%), and two acute pancreatitis (8%). ESDC occurred after a mean postoperative follow-up of 14 days (5-46), required emergency surgical treatment in 20 cases (77%), significantly prolonged the mean duration of hospitalization (96 days with ESDC vs 55 days without ESDC, p < 0.0001), and was responsible for death in five cases (19%). Surgical treatment included cholecystectomy (n = 11), bowel resection (n = 3), ulcer surgery (n = 2), subtotal colectomy (n = 2), Hartmann procedure (n = 1), and open coelioscopy (n = 1). Age and bilateral LT were found to be significant risk factors for ESDC in both uni- and multivariate analyses. CONCLUSION ESDC occurred in 7.4% of patients after LT without CPB, and was responsible for longer in-hospital stay. Relevant risk factors included older age and bilateral LT, interfering with current debate regarding recipients' selection and procedure's choice.
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Affiliation(s)
- Benoît Lahon
- Service de Chirurgie Thoracique, Vasculaire, et de Transplantation Pulmonaire, Hôpital Bichat, AP-HP, Université Denis Diderot - Paris 7, Paris, France
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Abstract
Among 450 patients who underwent lung transplantation (LuT) between April 1994 and April 2009 at a single academic hospital, 75 received surgical consultation, and 52 underwent 65 abdominal operations. Operations included colectomy (17), cholecystectomy (14), exploratory laparotomy (10), ulcer repair (five), hernia repair (four), Nissen fundoplication (four), pancreatic debridement (four), ostomy takedown (two), drainage of intra-abdominal abscess (two), and major vascular procedure, gastrostomy, splenectomy, fascial closure, laparoscopic common bile duct exploration, and small bowel resection (one each). Fourteen patients (27%) died within 30 days of surgery. On univariate analysis, age, race, comorbidities, history of previous abdominal surgery, transplant type, and timing of surgery after transplant were similar between the patients who survived and died. On multivariate analysis, emergent surgery, multiple medical comorbidities, and male gender were predictive of 30-day mortality ( P ≤ 0.05). Ulcer repair, major vascular procedures, pancreatic surgery, splenectomy, and exploratory laparotomy were associated with ≥ 50 per cent 30-day mortality. This is the largest series reporting outcomes of abdominal operations after LuT. Elective operations in LuT patients are safe, whereas emergent operations carry an extremely high short-term mortality rate. Aggressive prophylaxis for ulcer disease and early elective intervention for potential surgical problems, such as gallstones and uncomplicated diverticulitis, should be considered.
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Affiliation(s)
- Michael J. Leonardi
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Kevin G. Jamil
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Bryan Hiscox
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - David Ross
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Jonathan R. Hiatt
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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