title: Abdominal operations after lung transplantation. Indications and outcome.
abstract: OBJECTIVE
  To assess the outcomes of abdominal operations in patients with lung transplants and identify adverse risk factors.
  
  
  METHODS
  Matched cohort study.
  
  
  METHODS
  University referral center.
  
  
  METHODS
  Twelve lung transplant recipients who required abdominal operations (hereafter referred to as case patients) and 12 age-, sex-, and pulmonary diagnosis-matched lung transplant recipients who had not undergone an abdominal procedure (hereafter referred to as control patients).
  
  
  METHODS
  Elective abdominal operations including laparoscopic cholecystectomies (n = 5), laparoscopic repair of a colovaginal fistula (n = 1), and open colectomy for a benign colovesical fistula (n = 1) and urgent operations including bowel resections (n = 3), subtotal pancreatectomy (n = 1), and hepatorrhaphy for an iatrogenic liver injury (n = 1).
  
  
  METHODS
  Morbidity and mortality.
  
  
  RESULTS
  Abdominal operations were performed in 12 (11%) of the patients undergoing lung transplantation at the university referral center since 1987, with an associated mortality rate of 25%. Morbidity and mortality rates of electively performed procedures were 28% and 14%, respectively. An urgent indication for abdominal procedure was associated with 100% morbidity and 40% mortality. Compared with a matched group of 12 control patients, the long-term survival of the case patients was reduced (18% vs 64% at 4 years). Case patients undergoing an abdominal procedure in the posttransplantation period tended to have a higher prevalence of previous rejection (67% vs 25%), a higher perioperative steroid dosage (53 mg/d vs 36 mg/d), and a significantly lower posttransplantational forced expiratory volume in 1 second (FEV1, 1.23 L vs 1.91 L; P < .05).
  
  
  CONCLUSIONS
  Elective abdominal operations are relatively safe in properly prepared lung transplant recipients. However, laparotomy for urgent surgical conditions is associated with increased morbidity and mortality rates caused in part by the magnitude of the abdominal operation and influenced by the status of the lung transplant as manifested by previous rejection episodes, perioperative steroid dosages, and FEV1 values.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, San Antonio, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Pollard
authors.forename: W H
authors.initials: WH
authors.lastname: Schwesinger
authors.forename: E Y
authors.initials: EY
authors.lastname: Sako
authors.forename: K R
authors.initials: KR
authors.lastname: Sirinek
mesh_terms: D000206:Actuarial Analysis; D016022:Case-Control Studies; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000401:mortality; D008168:Lung / Q000503:physiopathology; D016040:Lung Transplantation; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome