Acute appendicitis after liver transplantation: A single center experience and review of the literature

Abstract

Backgrounds/Aims: Acute appendicitis is one of the most common emergent disease in the general population requiring surgical treatment. However, only a few cases of appendicitis after liver transplantation (LT) were reported. We described experiences of acute appendicitis after LT in single center. Methods: From March 1988 to July 2019, we reviewed retrospectively all the patients who diagnosed with acute appendicitis after LT at the Seoul National University Hospital. We described and analyzed clinical outcomes of appendectomy after LT. Results: A total of 12 patients out of 2,237 LT patients underwent appendectomy due to acute appendicitis. The mean age was 48±12 years. Nine patients (75%) underwent deceased donor liver transplantation (DDLT) and three patients (25%) underwent living donor liver transplantation (LDLT). The mean days from transplantation to the onset of acute appendicitis was 739 (range 57-4,496) days. Every patients underwent appropriate appendectomy within 1 days after visiting hospital. Leukocytosis was seen in three patients (25%). Seven patients (58%) underwent laparoscopic appendectomy and five patients (42%) underwent open appendectomy. The total operative time was 47.5 (range 25-135) minutes. The median postoperative hospitalization was 4 (range 2-11) days. There was no postoperative complications documented. There was no significant difference of clinical outcomes between laparoscopic appendectomy group and open appendectomy group. Conclusions: Early surgical management achieved satisfactory postoperative results without graft dysfunction after LT. Laparoscopic appendectomy also could be applicable with safe and feasible outcomes even in post-LT recipients.

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

“…IC patients with AA may show symptoms similar to the immunocompetent population, such as nausea/vomiting and fever along with right lower quadrant (RLQ) pain, but different laboratory pattern. Forty-three percent up to 76% of transplanted patients with AA had leukocytosis [ 92 , 93 ], fever, or migrating pain, but all patients had elevated CRP [ 94 ]. Sarici et al [ 95 ] conducted a case-control matched analysis confirming the incongruence in laboratory findings among transplanted patients with AA compared with non-immunocompromised patients.…”

“…In liver transplanted patients, cumulative incidence of AA ranges from 0.09 to 0.54% [ 82 , 92 – 94 , 96 ] demonstrating the rarity of this pathology in LT. In a recent meta-analysis, AA accounted only for 2% of all emergency surgery in transplanted patients [ 97 ].…”