Early laparotomy after lung transplantation: increased incidence for patients with α1-anti-trypsin deficiency.
BACKGROUND
Gastrointestinal complications after lung transplantation have been reported with incidence rates ranging from 3% to 51%, but the reasons are poorly understood. We aimed to investigate the correlations between pulmonary diseases leading to lung transplantation and early gastrointestinal complications requiring laparotomy after transplantation with outcomes for patients at increased risk.


METHODS
In this study we performed a retrospective analysis of data of patients who underwent lung transplantation at our institution from 2004 to 2012. The study period was limited to the first 90 days after transplantation.


RESULTS
Lung transplantation was performed in 258 patients, including 51 patients with α1-anti-trypsin deficiency (A1AD). Seventy-eight patients (30%) had an X-ray of the abdomen, and 23 patients (9%) required laparotomy during the first 90 days after transplantation. Patients with A1AD comprised 20% of the total recipients, 23% (18 of 78) of the patients who had an abdominal X-ray performed (p = 0.40), and 48% (11 of 23) of the patients who required laparotomy (p < 0.001). More than 1 of every 5 patients (11 of 51) with A1AD required laparotomy at a median 8 days after transplantation, and the estimated odds ratio for laparotomy for A1AD patients was 5.74 (CI 2.15 to 15.35). In the group of patients with A1AD who required laparotomy, the estimated hazard ratio for death was 1.62 (CI 0.57 to 4.62), the stay in the intensive care unit was prolonged, but no significant difference was observed for time on mechanical ventilation. Among pulmonary diseases and demographics of the patients, no other risk factors were identified for laparotomy.


CONCLUSIONS
A1AD was the only significant risk factor identified for gastrointestinal complications that required laparotomy within 3 months after lung transplantation. There was a trend toward a higher risk of death after laparotomy in patients with A1AD, and the length of stay in the intensive care unit was significantly prolonged, whereas the time on mechanical ventilation was unaffected.
Department of Cardiothoracic Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: p@bredahl.net.
Pia
P
Bredahl
Department of Cardiothoracic Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Mikhail
M
Zemtsovski
Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Michael
M
Perch
Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Dorte Levin
DL
Pedersen
Department of Surgical Gastroenterology, Division of Liver Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Allan
A
Rasmussen
Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Daniel
D
Steinbrüchel
Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Jørn
J
Carlsen
Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Martin
M
Iversen
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007813:Laparotomy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications*
abdominal surgery; alpha-1 antitrypsin deficiency; gastrointestinal complications; lung transplantation; ogilvie syndrome; pseudoobstruction