The impact of abdominal complications on the outcome after thoracic transplantation--a single center experience.
BACKGROUND
Abdominal complications after thoracic transplantation (Tx) are potentially associated with an increased risk of mortality. We recently reported about the severe outcome after bowel perforation in patients following lung transplantation (LuTx). The aim of the present study was to likewise identify the risk factors with an impact on patient survival following heart transplantation (HTx).


METHODS
A retrospective analysis for the frequency and outcome of abdominal interventions following HTx was performed in 342 patients, and these data thereafter compared to a re-evaluated pool of 1,074 patients following LuTx. All patients were transplanted at Hanover Medical School, Germany, between January 2000 and October 2011.


RESULTS
The incidence for abdominal surgery was comparable between patients following HTx (n = 33; 9.6 %) and LuTx (n = 90; 8.4 %). Elective operations were more frequently performed in patients after HTx (8.5 vs. 5.1 %). In contrast, the incidence of emergency interventions was higher after LuTx (5.3 %) than that following HTx (2.3 %). Herewith associated was the mortality observed in these transplant recipients (15.3 and 9.9 % for LuTx and HTx, respectively). Leading diagnosis for emergency surgery was bowel perforation (n = 18, regarding all cases). In 11 of these patients, perforation occurred within the first 6 months after Tx and eight of them died in the course of this complication (one patient after HTx and seven patients after LuTx).


CONCLUSIONS
Abdominal complications after HTx are less frequently than after LuTx but equally correlate with a high mortality rate. In finding or even reasonable suspicion of an acute abdomen after thoracic Tx, a broad practice for extended diagnostics and a low barrier for an early explorative laparotomy thus are recommended.
Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany, timrott.kai@mh-hannover.de.
K
K
Timrott
F W R
FW
Vondran
M
M
Kleine
G
G
Warnecke
A
A
Haverich
F
F
Lehner
J
J
Klempnauer
D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D007813:Laparotomy; D008171:Lung Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome