Acute appendicitis after solid organ transplantation

Abstract

Appendicitis has rarely been reported following solid organ transplantation and never following liver transplantation. We reviewed records of all patients who received solid organ transplants at UCLA between 1989 and 2002 and subsequently underwent appendectomy for presumed acute appendicitis. Of nearly 8000 transplant patients, 17 (nine male, eight female) subsequently underwent appendectomy for presumed acute appendicitis. Average age at appendectomy was 37 yrs (range 6-73 yrs). Organ transplants included liver (seven patients), heart (four), kidney (three), kidney-pancreas (two), and heart-kidney (one). The mean interval from transplant to appendectomy was 1064 d (16-2977). Presenting symptoms and signs included abdominal pain in 16 patients (94%); nausea and or vomiting in 15 (88%); right lower quadrant tenderness in 16; and leukocytosis (WBC > 10 000) in 13 (76%). Mean interval from presentation to appendectomy was 0.94 d (range 0-4). Computed tomography (CT) was performed in 16 patients and showed signs of acute appendicitis in 15. Open technique was used in all patients, preceded by laparoscopy in one. Pathology showed appendicitis in 15 patients (one with perforation), serositis in one, and a normal appendix in one. Mean duration of hospitalization was 7 d (range 1-20). Complications occurred in four patients (24%) and included intra-abdominal abscess requiring percutaneous drainage, ventral hernia, small bowel obstruction, and hematuria in one patient each. There were no deaths and no cases of acute rejection during hospitalization. Average length of follow-up was 712 d (range 3-2492). We conclude that appendicitis is relatively rare following solid organ transplantation. CT facilitates prompt diagnosis. The clinical presentation is similar to that of non-transplant patients, but complications are more frequent, and hospitalization is longer.

Acute Appendicitis Post Liver Transplant: A Case Report and Literature Review

“…Common laboratory findings are mostly white blood cells less than 10 × 10 9 /L and ranges from 2.3 to 26.4 × 10 9 /L. [2][3][4][5] Usually, the results of liver function and biochemical tests are normal.…”

“…2,4 Clinical presentation is similar to nonimmunocompromised patients, although most patients have nonspecific gastrointestinal symptoms. Right lower-quadrant pain is the most common symptom [2][3][4][5] and may be the only presenting symptom. 4 Associated symptoms include nausea (88%), 2-3 vomiting (88%), 2-3 and fever.…”

“…4 Associated symptoms include nausea (88%), 2-3 vomiting (88%), 2-3 and fever. [2][3][4][5] Owing to the immunosuppression, appendiceal inflammation is minimum, presentation is more atypical, and a high index of suspicion is needed for diagnosis. Common laboratory findings are mostly white blood cells less than 10 × 10 9 /L and ranges from 2.3 to 26.4 × 10 9 /L.…”

“…The reported incidence of acute appendicitis in liver transplant recipient is 0.01% to 0.49%. [2][3][4][5] Typically, the cause of acute appendicitis in nonimmunocompromised patients is multifactorial, with luminal obstruction from fecalith impaction or lymphoid hyperplasia as the main culprit. In liver transplant patients, luminal obstruction, bacteria overgrowth, lymphocytosis, and opportunistic infection owing to cytomegalovirus play a major role.…”

“…[2][3][4][5] The impaired immune function in these patients usually predisposes them to a delay in diagnosis owing to an atypical presentation, and this may increase the complication rate. 2 The present case discusses acute appendicitis after a liver transplant, the requirement for a high index of suspicion in this unique group of patients, feasibility of laparoscopic appendectomy, and extensive review of literature on the subject.…”