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1
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Hage R, Hoier D, Chatzidaki E, Roeder M, Schuurmans MM. Severe Abdominal Complications in Lung Transplant Recipients. EXP CLIN TRANSPLANT 2024; 22:933-939. [PMID: 39810579 DOI: 10.6002/ect.2024.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
OBJECTIVES Lung transplant is a complex procedure with potential for substantial postoperative complications, including abdominal issues. Although previous studies have suggested that preexisting gastrointestinal conditions may be associated with a high risk of posttransplant complications, the evidence remains inconsistent. We aimed to explore the incidence rates, risk factors, and outcomes of abdominal complications within the first year following lung transplant. MATERIALS AND METHODS We conducted a retrospective cohort study at the University Hospital Zurich of 68 lung transplant recipients who experienced abdominal complications within 1 year after transplant. Data were collected from medical records on baseline demographic and clinical characteristics, including pretransplant gastrointestinal and hepatobiliary diseases. We used descriptive statistics (Fisher exact test, chi-square test, and Cramer V test) to assess outcome details, such as the timing and type of abdominal complications, surgical interventions, and associations with pretransplant conditions. RESULTS Abdominal complications occurred at a mean of 43 days posttransplant, with bowel ischemia and perforation as the most common reasons for posttransplant surgical intervention. Symptoms leading to surgery included nausea and abdominal pain, and 1 of 8 patients with abdominal surgery (12.5%) died after surgery. Notably, no significant associations were found between pretransplant factors (ie, gastrointestinal disease, hepatobiliary disease, body mass index >24, smoking status, peripheral vascular disease, and diabetes) and the occurrence of posttransplant abdominal surgery. Effect size analyses indicated very weak associations, suggesting that these pretransplant conditions are not strong predictors of postoperative abdominal complications. CONCLUSIONS Our results showed that preexisting gastrointestinal and hepatobiliary conditions, along with other common pretransplant factors, were not significant predictors of abdominal complications following lung transplant. Future studies should focus on intraoperative and immediate postoperative factors and should explore the role of minimally invasive surgical techniques and potential benefits of earlier or more comprehensive pretransplant screening.
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Affiliation(s)
- René Hage
- >From the Division of Pulmonology, University Hospital Zurich, and the Faculty of Medicine, University of Zurich, Zurich, Switzerland
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2
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Reiche W, Tauseef A, Sabri A, Mirza M, Cantu D, Silberstein P, Chandan S. Gastrointestinal manifestations, risk factors, and management in patients with post-transplant lymphoproliferative disorder: A systematic review. World J Transplant 2022; 12:268-280. [PMID: 36159076 PMCID: PMC9453293 DOI: 10.5500/wjt.v12.i8.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with a history of solid organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT) are at an increased risk of developing post-transplant lymphoproliferative disorder (PTLD). The gastrointestinal (GI) tract is commonly affected as it has an abundance of B and T cells. AIM To determine typical GI-manifestations, risk factors for developing PTLD, and management. METHODS Major databases were searched until November 2021. RESULTS Non-case report studies that described GI manifestations of PTLD, risk factors for developing PTLD, and management of PTLD were included. Nine articles written within the last 20 years were included in the review. All articles found that patients with a history of SOT, regardless of transplanted organ, have a propensity to develop GI-PTLD. CONCLUSION GI tract manifestations may be nonspecific; therefore, consideration of risk factors is crucial for identifying GI-PTLD. Like other lymphoma variants, PTLD is very aggressive making early diagnosis key to prognosis. Initial treatment is reduction of immunosuppression which is effective in more than 50% of cases; however, additional therapy including rituximab, chemotherapy, and surgery may also be required.
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Affiliation(s)
- William Reiche
- Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
| | - Abubakar Tauseef
- Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
| | - Ahmed Sabri
- Department of Pathology, CHI Creighton University Medical Center, Omaha, NE 68124, United States
| | - Mohsin Mirza
- Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
| | - David Cantu
- Department of Pathology, CHI Creighton University Medical Center, Omaha, NE 68124, United States
| | - Peter Silberstein
- Division of Hematology and Oncology, Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
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3
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Zywot A, Turner AL, Sesti J, Langan RC, Nguyen A, de Biasi AR, Raja S, Ahmad U, Paul S. Morbidity and mortality after general surgery in heart and lung transplant patients. Surg Open Sci 2020; 2:140-146. [PMID: 32754719 PMCID: PMC7391886 DOI: 10.1016/j.sopen.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Heart and lung transplant patients can develop conditions necessitating general surgery procedures. Their postoperative morbidity and mortality remain poorly characterized and limited to case series from select centers. METHODS The National Inpatient Sample (1998-2015) was used to identify 6433 heart and 3015 lung transplant patient admissions for general surgery procedures. For a comparator group, we identified 23,764,164 nontransplant patient admissions for the same procedures. Patient morbidity and mortality after general surgery were compared between transplant patients and nontransplant patients. Data were analyzed with frequency tables, χ 2 analysis, and a mixed-effects multivariate regression. RESULTS Overall mortality was higher and length of stay longer in the transplant group compared to the nontransplant group. Analysis revealed that hospital size and comorbidities were predictors of mortality for patients undergoing certain general surgery procedures. Transplant status alone did not predict mortality. CONCLUSION Our findings demonstrate that heart and lung transplant patients, compared to nontransplant patients, have more complications and a higher length of stay after certain general surgery procedures.
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Affiliation(s)
- Alek Zywot
- Thoracic Surgical Services, RWJBarnabas Health, Saint Barnabas Medical Center, West Orange, NJ
| | - Amber L. Turner
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, NJ
| | - Joanna Sesti
- Thoracic Surgical Services, RWJBarnabas Health, Saint Barnabas Medical Center, West Orange, NJ
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, NJ
| | - Russell C. Langan
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, NJ
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Andrew Nguyen
- Thoracic Surgical Services, RWJBarnabas Health, Saint Barnabas Medical Center, West Orange, NJ
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Usman Ahmad
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
- Transplantation Institute, Cleveland Clinic, Cleveland, OH
| | - Subroto Paul
- Thoracic Surgical Services, RWJBarnabas Health, Saint Barnabas Medical Center, West Orange, NJ
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, NJ
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
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4
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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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5
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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: 0.4] [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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6
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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: 1.5] [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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7
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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: 0.7] [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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8
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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: 0.8] [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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9
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Tague LK, Adams W, Young KA, Kwon OJ, Mahoney E, Lowery EM. Association between diverticular disease requiring surgical intervention and mortality in the postlung transplant population - a retrospective cohort study. Transpl Int 2019; 32:739-750. [PMID: 30793380 DOI: 10.1111/tri.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2018] [Accepted: 02/18/2019] [Indexed: 12/25/2022]
Abstract
Lung Transplant recipients are at increased risk of complicated diverticular disease. We aim to assess the rate of diverticular surgery in a postlung transplantation population and identify risk factors for surgery. We performed a retrospective cohort study of lung transplant recipients from 2007 to 2011. Demographic variables were evaluated with the Mann-Whitney U and chi-squared tests. Cox regression was performed to evaluate 1- and 2-year landmark survival, assess predictor variables of diverticular surgery and evaluate impact of surgery on CLAD development. Of 17 of 158 patients (10.7%) underwent diverticular-related surgery. Surgical patients had significantly worse survival than nonsurgical patients at 1 year [aHR 2.93 (1.05-8.21), P = 0.041] and 2 year [aHR 4.17 (1.26-13.84), P = 0.020] landmark analyses. Transplant indication of alpha-1 antitrypsin disease and cystic fibrosis were significantly associated with the need for diverticular surgery. Emergent surgery was associated with poorer survival [aHR 5.12(1.00-26.27), P = 0.050]. Lung transplant patients requiring surgery for complicated diverticular disease have significantly poorer survival than those who do not require surgery. Surgery was more common in patients transplanted for A1AT and CF. Optimal assessment and risk stratification of diverticular disease is necessary to prevent excessive morbidity and mortality following transplantation.
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Affiliation(s)
- Laneshia K Tague
- Department of Medicine, Division of Pulmonary and Critical Care, Washington University in St. Louis, St. Louis, MO, USA
| | - William Adams
- Department of Public Health, Loyola University Chicago Health Science Division, Maywood, IL, USA
| | - Katherine A Young
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago Health Science Division, Maywood, IL, USA
| | - Oh Jin Kwon
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Erin Mahoney
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago Health Science Division, Maywood, IL, USA
| | - Erin M Lowery
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago Health Science Division, Maywood, IL, USA.,Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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10
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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: 0.6] [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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11
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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: 0.7] [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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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: 3.2] [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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13
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The impact of abdominal complications on the outcome after thoracic transplantation--a single center experience. Langenbecks Arch Surg 2014; 399:789-93. [PMID: 24722781 DOI: 10.1007/s00423-014-1193-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 03/30/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Abdominal complications after thoracic transplantation (Tx) are potentially associated with an increased risk of mortality. We recently reported about the severe outcome after bowel perforation in patients following lung transplantation (LuTx). The aim of the present study was to likewise identify the risk factors with an impact on patient survival following heart transplantation (HTx). METHODS A retrospective analysis for the frequency and outcome of abdominal interventions following HTx was performed in 342 patients, and these data thereafter compared to a re-evaluated pool of 1,074 patients following LuTx. All patients were transplanted at Hanover Medical School, Germany, between January 2000 and October 2011. RESULTS The incidence for abdominal surgery was comparable between patients following HTx (n = 33; 9.6 %) and LuTx (n = 90; 8.4 %). Elective operations were more frequently performed in patients after HTx (8.5 vs. 5.1 %). In contrast, the incidence of emergency interventions was higher after LuTx (5.3 %) than that following HTx (2.3 %). Herewith associated was the mortality observed in these transplant recipients (15.3 and 9.9 % for LuTx and HTx, respectively). Leading diagnosis for emergency surgery was bowel perforation (n = 18, regarding all cases). In 11 of these patients, perforation occurred within the first 6 months after Tx and eight of them died in the course of this complication (one patient after HTx and seven patients after LuTx). CONCLUSIONS Abdominal complications after HTx are less frequently than after LuTx but equally correlate with a high mortality rate. In finding or even reasonable suspicion of an acute abdomen after thoracic Tx, a broad practice for extended diagnostics and a low barrier for an early explorative laparotomy thus are recommended.
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14
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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: 0.7] [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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