title: Acute care surgery after renal transplantation.
abstract: Emergent operation after renal transplantation (RT) has traditionally been associated with substantial morbidity and mortality. We reviewed 2340 adult patients who underwent RT at our tertiary care center and identified 55 patients who required acute care surgical consultation within 1 year of transplantation. Of these, 43 were treated operatively and 12 nonoperatively. Primary diagnoses were intestinal problems in 29 patients (53%), including diverticulitis, ischemia, perforation, obstruction, and bleeding; cholecystitis in 10 (18%); fluid collections in six (11%), appendicitis and hernias in two each (4%); gastritis in one (2%); and no diagnosis in five (9%). Colonic pathology was treated with resection and diversion in 14 of 16 patients who underwent surgery. Acute allograft rejection preceded the surgical problem in five patients. Complications occurred in 13 per cent of patients, and mortality was 9 per cent. Colonic ischemia had a fulminating presentation and particular morbidity. We conclude that acute gastrointestinal emergencies after RT are rare and that early and aggressive intervention using an acute care surgical model yields excellent results.
authors.affiliation: Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6904, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Benjamin
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jim
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kim
authors.forename: Clifton
authors.initials: C
authors.lastname: Meals
authors.forename: H Albin
authors.initials: HA
authors.lastname: Gritsch
authors.forename: Areti
authors.initials: A
authors.lastname: Tillou
authors.forename: H Gill
authors.initials: HG
authors.lastname: Cryer
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures; D004630:Emergencies; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006555:Hernia, Ventral / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult