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Presenter: Undine, Gerlach, Berlin, Germany
Authors: Undine Gerlach, Georgios Vrakas, Srikanth Reddy, Pratschke Johann, Andreas Pascher, Peter Friend, Anil Vaidya
Undine Gerlach1, Georgios Vrakas2, Srikanth Reddy2, Pratschke Johann1, Andreas Pascher1, Peter Friend2, Anil Vaidya3.
1Department of Surgery, Charité - UNiversitaetsmedizin Berlin, Berlin, Germany; 2Oxford Transplant Centre, University of Oxford, Oxford, United Kingdom; 3Transplant Centre, Apollo Hospitals, Chennai, India
Background: Intestinal and multivisceral transplant recipients have often undergone mulitple operations prior to and early after transplantation. In addition, they receive high amounts of immunosupression. Thus abdominal surgery at a later stage posttransplant is very challenging and may increase the morbidity and mortality of these fragile patients.
Methods: We retrospectively studied 69 patients (27 female, 42 male, 37±9 years) with isolated intestinal (ITX, n=48), modified (mMVTX, n=7) or typical multivisceral transplantation (MVTX, n=15) in 2 large european transplant centres. 4 grafts included a kidney and 17 included the abdominal wall. Maintenance immunosuppression consisted of either Tacrolimus Monotherapy in 31 patients or a double combination of Tacrolimus/MMF, Tacrolimus/Sirolimus, Tacrolimus/Everolimus.
We recorded all intraabdominal interventions, which were performed after the first year posttransplant, and subdivided them into 2 groups depending on whether or not they were related to the intestinal graft.
Results: The median follow-up time posttransplant was 8 years [1;15]. 20 intraabdominal operations were reported in 15 patients after a median of 5 years [1;13] posttransplant.
81% were emergency operations:
Graft-related surgery was required due to graft ischeamia (n=2), adhesive ileus (n=3) and encapsulating ileus (n=2). Surgery for these patients included partial graft resection (n=5), graft explantation (n=4) and intestinal retransplantation (n=1).
Non graft-related operations did not affect the graft or graft function and were: native colon resection due to Volvulus (n=1), native nephrectomy due to outflow obstruction (n=1), kidney transplantation due to CNI-toxicity (n=1), cholecystectomy due to necrotic cholecystitis (n=1), caesarian (n=1), post-mortem kidney/liver donation (n=1).
There were no deaths related to surgery.
19% was elective surgery: Incisional herniotomy at the previous stoma-site (n=3) and a bilateral inguinal herniotomy without incarceration(n=1).
A conservative treatment was attempted in 4 patients with: rectovaginal fistula in a stapled rectum stump (n=1), neutropenic colitis (n=1) and upper GI-haemorrhage (n=2). The latter 2 patients died.
The median hospital stay following surgery was 27 days [7;210]. Six patients had to undergo repeated surgery (median number of operations 3 [2;13]).
Conclusion: Abdominal surgery in ITX and (m)MVTX-recipients is challenging but feasible. Especially graft-related surgery was accompanied with a high risk of graft-loss but not with mortality. Non graft-related surgery did not affect graft function or longterm survival.
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