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Incidence and outcome of abdominal surgical interventions following lung transplantation—a single center experience

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Abstract

Purpose

Abdominal complications after lung transplantation (LuTx) are associated with a high mortality risk. Aim of the present study was to analyse frequency and outcome of abdominal interventions following LuTx.

Methods

Retrospective analysis of the requirement of abdominal surgery including data of 754 patients undergoing LuTx at the Hannover Medical School, Germany, between January 2000 and December 2008.

Results

In the course of lung transplantation, 55 patients (7%) were in need of surgical interventions due to abdominal complications. Following LuTx, 35 individuals were operated in 43 cases of emergency indication. The leading diagnosis was bowel perforation (n = 10) with surgery performed 10.4 months after LuTx, although 7 of 10 patients were operated within the first 4 weeks post-transplantation. Emergency interventions were associated with a mortality rate of 28%, 42% thereof after bowel perforation. Elective surgical treatments (n = 31) were diverse and had no influence on mortality.

Conclusions

Early abdominal complications after LuTx correlate with a high mortality rate. Perforation of the bowel was the leading diagnosis with a severe impact on the outcome. Thus, in cases of an acute abdomen after LuTx, we recommend the broad use of further diagnostic measures as well as an early decision for explorative laparotomy.

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References

  1. Hertz MI, Aurora P, Christie JD, Dobbels F, Edwards LB, Kirk R, Kucheryavaya AY, Rahmel AO, Rowe AW, Taylor DO (2008) Registry of the International Society for Heart and Lung Transplantation: a quarter century of thoracic transplantation. J Heart Lung Transplant 27:937–942

    Article  PubMed  Google Scholar 

  2. Christie JD, Edwards LB, Aurora P, Dobbels F, Kirk R, Rahmel AO, Taylor DO, Kucheryavaya AY, Hertz MI (2008) Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult lung and heart/lung transplantation report—2008. J Heart Lung Transplant 27:957–969

    Article  PubMed  Google Scholar 

  3. Augustine SM, Yeo CJ, Buchman TG, Achuff SC, Baumgartner WA (1991) Gastrointestinal complications in heart and in heart-lung transplant patients. J Heart Lung Transplant 10:547–555

    PubMed  CAS  Google Scholar 

  4. Cates J, Chavez M, Laks H, Drinkwater D, Stevenson L, Kobashigawa J, Saunders K, Abedin M, Roslyn J (1991) Gastrointestinal complications after cardiac transplantation: a spectrum of diseases. Am J Gastroenterol 86:412–416

    PubMed  CAS  Google Scholar 

  5. Kirklin JK, Holm A, Aldrete JS, White C, Bourge RC (1990) Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention. Ann Surg 211:538–541

    Article  PubMed  CAS  Google Scholar 

  6. Merrell SW, Ames SA, Nelson EW, Renlund DG, Karwande SV, Burton NA, Sullivan JJ, Jones KW, Gay WA Jr (1989) Major abdominal complications following cardiac transplantation. Utah Transplantation Affiliated Hospitals Cardiac Transplant Program. Arch Surg 124:889–894

    PubMed  CAS  Google Scholar 

  7. Steck TB, Durkin MG, Costanzo-Nordin MR, Keshavarzian A (1993) Gastrointestinal complications and endoscopic findings in heart transplant patients. J Heart Lung Transplant 12:244–251

    PubMed  CAS  Google Scholar 

  8. Steed DL, Brown B, Reilly JJ, Peitzman AB, Griffith BP, Hardesty RL, Webster MW (1985) General surgical complications in heart and heart-lung transplantation. Surgery 98:739–745

    PubMed  CAS  Google Scholar 

  9. Watson CJ, Jamieson NV, Johnston PS, Wreghitt T, Large S, Wallwork J, English TA (1991) Early abdominal complications following heart and heart-lung transplantation. Br J Surg 78:699–704

    Article  PubMed  CAS  Google Scholar 

  10. Canter JW, Shorb PE Jr (1971) Acute perforation of colonic diverticula associated with prolonged adrenocorticosteroid therapy. Am J Surg 121:46–51

    Article  PubMed  CAS  Google Scholar 

  11. ReMine SG, McIlrath DC (1980) Bowel perforation in steroid-treated patients. Ann Surg 192:581–586

    Article  PubMed  CAS  Google Scholar 

  12. Sterioff S, Orringer MB, Cameron JL (1974) Colon perforations associated with steroid therapy. Surgery 75:56–58

    PubMed  CAS  Google Scholar 

  13. Tyau ES, Prystowsky JB, Joehl RJ, Nahrwold DL (1991) Acute diverticulitis. A complicated problem in the immunocompromised patient. Arch Surg 126:855–858

    PubMed  CAS  Google Scholar 

  14. Warshaw AL, Welch JP, Ottinger LW (1976) Acute perforation of the colon associated with chronic corticosteroid therapy. Am J Surg 131:442–446

    Article  PubMed  CAS  Google Scholar 

  15. Wekerle T, Klepetko W, Wisser W, Senbaklavaci O, Artemiou O, Zuckermann A, Wolner E (1997) Incidence and outcome of major non-pulmonary surgical procedures in lung transplant recipients. Eur J Cardiothorac Surg 12:718–723

    Article  PubMed  CAS  Google Scholar 

  16. Taylor DO, Edwards LB, Aurora P, Christie JD, Dobbels F, Kirk R, Rahmel AO, Kucheryavaya AY, Hertz MI (2008) Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report—2008. J Heart Lung Transplant 27:943–956

    Article  PubMed  Google Scholar 

  17. Cheadle WG, Mercer-Jones M, Heinzelmann M, Polk HC Jr (1996) Sepsis and septic complications in the surgical patient: who is at risk? Shock 6:6–9

    Article  Google Scholar 

  18. Beaver TM, Fullerton DA, Zamora MR, Badesch DB, Weill D, Brown JM, Campbell DN, Grover FL (1996) Colon perforation after lung transplantation. Ann Thorac Surg 62:839–843

    Article  PubMed  CAS  Google Scholar 

  19. Maurer JR (2000) The spectrum of colonic complications in a lung transplant population. Ann Transplant 5:54–57

    PubMed  CAS  Google Scholar 

  20. Hoekstra HJ, Hawkins K, de Boer WJ, Rottier K, van der Bij W (2001) Gastrointestinal complications in lung transplant survivors that require surgical intervention. Br J Surg 88:433–438

    Article  PubMed  CAS  Google Scholar 

  21. Goldberg HJ, Hertz MI, Ricciardi R, Madoff RD, Baxter NN, Bullard KM (2006) Colon and rectal complications after heart and lung transplantation. J Am Coll Surg 202:55–61

    Article  PubMed  Google Scholar 

  22. Paul S, Escareno CE, Clancy K, Jaklitsch MT, Bueno R, Lautz DB (2009) Gastrointestinal complications after lung transplantation. J Heart Lung Transplant 28:475–479

    Article  PubMed  Google Scholar 

  23. Fenton JJ, Cicale MJ (1997) Sigmoid diverticular perforation complicating lung transplantation. J Heart Lung Transplant 16:681–685

    PubMed  CAS  Google Scholar 

  24. Pollard TR, Schwesinger WH, Sako EY, Sirinek KR (1997) Abdominal operations after lung transplantation. Indications and outcome. Arch Surg 132:714–717

    PubMed  CAS  Google Scholar 

  25. Smith PC, Slaughter MS, Petty MG, Shumway SJ, Kshettry VR, Bolman RM 3rd (1995) Abdominal complications after lung transplantation. J Heart Lung Transplant 14:44–51

    PubMed  CAS  Google Scholar 

  26. Dominguez-Fernandez E, Albrecht KH, Heemann U, Kohnle M, Erhard J, Stöblen F, Eigler FW (1998) Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease. Transpl Int 11:28–31

    Article  PubMed  CAS  Google Scholar 

  27. Catena F, Ansaloni L, Gazzotti F, Bertelli R, Severi S, Coccolini F, Fuga G, Nardo B, D'Alessandro L, Faenza A, Pinna AD (2008) Gastrointestinal perforations following kidney transplantation. Transplant Proc 40:1895–1896

    Article  PubMed  CAS  Google Scholar 

  28. Benjamin ER, Jim J, Kim TJ, Meals C, Gritsch HA, Tillou A, Cryer HG, Hiatt JR (2009) Acute care surgery after renal transplantation. Am Surg 75:882–886

    PubMed  Google Scholar 

  29. Kaplan CS, Petersen EA, Icenogle TB, Copeland JG, Villar HV, Sampliner R, Minnich L, Ray CG (1989) Gastrointestinal cytomegalovirus infection in heart and heart-lung transplant recipients. Arch Intern Med 149:2095–2100

    Article  PubMed  CAS  Google Scholar 

  30. Toogood GJ, Gillespie PH, Gujral S, Warren BF, Roake JA, Gray DW, Morris PJ (1996) Cytomegalovirus infection and colonic perforation in renal transplant patients. Transpl Int 9:248–251

    Article  PubMed  CAS  Google Scholar 

  31. Sharma S, Reddy V, Ott G, Sheppard B, Ratkovec R, Hershberger R, Norman D, Hosenpud J, Cobanoglu A (1996) Gastrointestinal complications after orthotopic cardiac transplantation. Eur J Cardiothorac Surg 10:616–620

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Kai Timrott.

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Timrott, K., Vondran, F.W.R., Jaeger, M.D. et al. Incidence and outcome of abdominal surgical interventions following lung transplantation—a single center experience. Langenbecks Arch Surg 396, 1231–1237 (2011). https://doi.org/10.1007/s00423-011-0754-2

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  • DOI: https://doi.org/10.1007/s00423-011-0754-2

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