Original scientific article
Intraabdominal Complications after Lung Transplantation

https://doi.org/10.1016/j.jamcollsurg.2006.07.024Get rights and content

Background

Because more lung transplant recipients survive the perioperative period, nonpulmonary complications become a major source of morbidity and mortality. Of these, intraabdominal complications are of particular concern because of the potential need for surgical intervention. So appropriate management of these complications becomes paramount.

Study design

We retrospectively reviewed 229 lung transplant recipients in a university medical center, between January 1997 and December 2004 developed in forty-seven patients. Abdominal complications. Detailed reviews of these patients’ hospital charts were performed. Complications were categorized as early or late depending on if they occurred within 30 days of transplantation or later. The primary outcomes variable studied was mortality.

Results

Fifty-three surgical consultations for abdominal symptoms were requested in these 47 patients. Twenty-two of the 47 patients (47%) with intraabdominal complications required 24 operative interventions. Overall 5-year survival was substantially worse in patients with intraabdominal complications (34%) than in those without (62%, p = 0.01). There was no marked difference in the 30-day mortality for patients experiencing early (27%, 4 of 15) versus late (24%, 9 of 38) complications. Mortality in patients with intraabdominal complications was lower among those treated operatively (n = 2, 9%) compared with those treated nonoperatively (n = 11, 44%, p = 0.02).

Conclusions

Mortality for patients with intraabdominal complications is high after lung transplantation. Operative intervention is well tolerated and associated with lower mortality. A high index of suspicion and timely operative intervention are necessary for the treatment of intraabdominal complications in lung transplant recipients.

Section snippets

Methods

This retrospective study included all patients receiving lung transplants between January 1997 and December 2004 at Loyola University Medical Center, Maywood, IL. Approval from the hospital Institutional Review Board for Protection of Human Subjects was obtained for reviewing patient charts and the lung transplantation database. The study group was comprised of patients requiring a general surgery consultation for experiencing of intraabdominal complications. The overall survival of lung

Results

Between January 1997 and December 2004, 232 lung transplantations were performed in 229 patients at Loyola University Medical Center. The patient population consisted of 134 women and 95 men, with a mean age of 48 years at the time of transplantation (range 15 to 65 years). Indications for transplantation (Fig. 1) were most commonly obstructive lung disease (COPD, n = 63) and alpha1 deficiency (n = 24), pulmonary fibrosis (n = 51), and cystic fibrosis (n = 41). Of the 232 procedures, 123 (53%) were

Discussion

Intraabdominal complications are not uncommon in lung transplant patients. We report a 21% complication rate in 229 consecutive lung transplantations. Smith and colleagues7 reported a similar rate in a smaller series of 75 patients, and Wekerle and associates8 reported a rate of 13% in 124 patients undergoing lung transplantation. In the former series, an omental wrap was used for bronchial anastomosis, an abdominal procedure was required during the lung transplantation. This may explain the

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  • Cited by (0)

    Competing Interests Declared: None.

    1

    Drs Garrity and Vigneswaran are currently at the University of Chicago, Chicago, IL.

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