Emergency abdominal surgery after solid organ transplantation: a systematic review

Area of Science:

• Transplant Surgery
• Abdominal Surgery
• Gastroenterology

Background:

• Solid organ transplantation rates are increasing globally.
• Emergency abdominal surgery in transplant recipients presents unique challenges for general surgeons.

Purpose of the Study:

• To systematically review the literature on morbidity and mortality associated with emergency abdominal surgery in solid organ transplant patients.
• To analyze outcomes of graft-unrelated emergency abdominal surgical problems in transplanted individuals.

Main Methods:

• A systematic literature search was conducted for studies published between 1990 and 2015.
• Included studies described emergency abdominal surgery in any solid organ transplant recipient.

Main Results:

• 39 case series (1996-2015) involving 71,671 transplant patients were reviewed; 1761 (2.5%) underwent emergency abdominal surgery.
• Common indications included gallbladder disease (80.3%), gastrointestinal perforations (9.2%), and complicated diverticulitis (6.2%). Overall mortality was 5.5%, with morbidity varying by condition.
• Heart (65.8%) and lung (22.1%) were the most frequently transplanted organs. Median time to surgery was 2.4 years post-transplant.

Conclusions:

• Emergency abdominal surgery in transplant patients is a relevant clinical event.
• The procedure is associated with significant morbidity and mortality.
• Appropriate surgical management, considering immunosuppression and hemodynamic stability, is crucial for achieving satisfactory results.