Emergency abdominal surgery after solid organ transplantation: a systematic review

Abstract

AimsDue 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.MethodsThe 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.ResultsThirty-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.ConclusionsEmergency 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.

Abdominal emergencies after liver transplantation: Presentation and surgical management

“…To support elective resection, the postoperative outcome after elective procedure was no different from that in immunocompetent patients. The often‐significant severity of sigmoid diverticulitis among transplant recipients has prompted consideration of pre‐transplant prophylactic surgery for patients with sigmoid diverticulosis proven by colonoscopy, but this is a feasible approach only for kidney transplant candidates, as patients awaiting heart, lung, or LT are generally too sick to tolerate any major surgical procedures …”

“…Although acute appendicitis accounts for over 1 million patient days of admission in the United States, incidence of acute appendicitis after LT has been reported as being very low 61,62 : 2% of abdominal surgery after LT is related to acute appendicitis. 62 However, there was a high percentage of misdiagnosis with a markedly high incidence of complicated appendicitis. Clinical presentation is similar to nonim-…”

Surgical approach, cost, and complications of appendectomy in kidney transplant recipients

“…Previous studies have reported that postoperative outcomes for solid organ transplant recipients following general surgical procedures are worse than the general population, with a recent review citing up to 32.7% mortality and 17.5% morbidity for emergency abdominal surgery, in comparison with 9% morbidity in nontransplant recipients . For appendectomy specifically, in the largest case series to date that included transplant recipients, there were only 17 appendectomies reported, and only 3 of those performed on KTR.…”

“…Appendicitis is one of the most common surgical diseases in the United States, with a lifetime risk of 6.7% in females and 8.6% in males . Like the general population, kidney transplant recipients (KTRs) are at risk of requiring appendectomy, although the incidence of appendicitis in KTR has not been well documented outside of small case series . Further, while post‐appendectomy morbidity is low in the general population (4.1%‐6.4%) and average postoperative length of stay (LOS) is short (0‐2.4 days), it is unknown whether risk, LOS, and, thus, hospital‐associated cost are amplified for KTR .…”

“…abdominal surgery, in comparison with 9% morbidity in nontransplant recipients. 2,11 For appendectomy specifically, in the largest case series to date that included transplant recipients, there were only 17 appendectomies reported, and only 3 of those performed on KTR.…”