Morbidity and mortality of serious gastrointestinal complications after lung transplantation

Zevallos-Villegas, Annette; Alonso-Moralejo, Rodrigo; Cambra, F.; Hermida-Anchuelo, Ana; Pérez-González, Virginia; Gámez-García, Pablo; Sayas-Catalán, Javier; Gafas, Alicia de Pablo

doi:10.1186/s13019-019-0983-y

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…Serious gastrointestinal complications, such as diverticulitis, are common after lung transplant and are associated with considerable increases in morbidity and mortality. 14,15 The incidence of posttransplant diverticulitis in our cohort (3.32%) was lower than the findings of the most recent studies (4.4%-12.4%) 6,12,16 ; however, it is much higher than that reported in the general population (0.7%). 17 Our results are consistent with previous studies reporting that over 60% of diverticulitis cases occur within 2 years of transplant.…”

Section: Discussioncontrasting

confidence: 78%

Management and Outcomes of Diverticulitis After Lung Transplantation

et al. 2020

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Introduction: Most lung transplant patients are older than 50 years. Complications from colonic diverticula are not uncommon, especially with chronic immunosuppression. However, limited data exist regarding the optimal management of these patients. We sought to investigate the incidence, risk factors, and outcomes of diverticulitis after lung transplant. Methods: We conducted a retrospective study to review patients undergoing lung transplant between 2007 and 2016 with posttransplant acute colonic diverticulitis. Patients were grouped based on medical or surgical management. Results: Of 512 transplant recipients, 17 (3.32%) developed 26 episodes of diverticulitis over a median follow-up of 39 months. Nine patients had documented diverticulosis on pretransplant colonoscopy. These patients had a higher incidence of surgical intervention for diverticulitis, were more likely to have recurrent diverticulitis, and had longer lengths of stay than patients without pretransplant diverticulosis. Six (35.3%) of 17 patients required surgery (ie, Hartmann procedure; 4 during the initial episode and 2 during their third and fourth episodes); 11 patients (64.7%) were managed with antibiotics alone. Patients in the surgical group presented earlier posttransplant ( P = .004) and were on higher doses of tacrolimus ( P = .03). Six (46.1%) of 13 patients with medically managed first episodes of diverticulitis experienced recurrence. No recurrence occurred after surgical management. No deaths were attributable to diverticulitis in either group. Conclusions: Patients with pretransplant diverticulosis experienced earlier, more complicated episodes of diverticulitis posttransplant than patients without. Surgical patients received higher doses of tacrolimus and presented earlier than medical patients. Uncomplicated diverticulitis in posttransplant patients can be managed medically, even in the case of recurrent, uncomplicated disease.

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Section: Discussioncontrasting

confidence: 78%

Management and Outcomes of Diverticulitis After Lung Transplantation

et al. 2020

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“…Several studies have reported abdominal complications of varying severity at a rate of 21 to 62% after LTx. [21,22] Prolonged operative time, postoperative epidural analgesia, immunosuppressive drugs, and electrolyte imbalance play a role in these complications. [23] In the present study, the rate of GI complications was higher among patients receiving a higher amount of fluid (Group 2).…”

Section: Discussionmentioning

confidence: 99%

Effects of intraoperative fluid therapy on intensive care process, morbidity, and mortality after lung transplantation

Özay¹,

Yazicioğlu

Bindal³

et al. 2023

Turk Gogus Kalp Dama

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Background: This study aims to evaluate the effect of intraoperative fluid therapy on intensive care process and first 90-day morbidity and mortality in patients undergoing lung transplantation. Methods: Between March 2013 and December 2020, a total of 77 patients (64 males, 13 females; mean age: 47.6±13.0 years; range, 19 to 67 years) who underwent lung transplantation were retrospectively analyzed. The patients were divided into two groups according to the amount of fluid given intraoperatively: Group 1 (<15 mL/kg-1/h-1) and Group 2 (>15 mL/kg-1/h-1). Demographic, clinical, intra- and postoperative data of the patients were recorded. Results: Less than 15 mL/kg-1/h-1 f luid w as a dministered t o 75.3% (n=58) of the patients (Group 1) and 24.7% (n=19) were administered more than 15 mL/kg-1/h-1 (Group 2). In t erms of native disease, the rate of diagnosis of chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis was higher in Group 1, and the rate of other diagnoses was higher in Group 2 (p<0.01). The ratio of women in Group 2 was higher (p<0.05), while the body mass index values were significantly lower in this group (p<0.01). The erythrocyte, fresh frozen plasma, platelet, crystalloid and total fluid given in Group 2 were significantly higher (p<0.001). Inotropic/vasopressor agent use rates and extracorporeal membrane oxygenation requirement were significantly higher in Group 2 (p<0.01). Primary graft dysfunction, gastrointestinal complications, and mortality rates were also significantly higher in Group 2 (p<0.05). Conclusion: The increased intraoperative fluid volume in lung transplantation is associated with primary graft dysfunction, gastrointestinal complications, and mortality rates.

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“…Peptic ulcer disease was also a risk for mortality in our study. It is reported from small series to occur and reoccur after transplantation and may lead to intestinal perforation ( 28 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation

Ehrsam¹,

Schuurmans²,

Laager³

et al. 2022

Transpl Int

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Since candidates with comorbidities are increasingly referred for lung transplantation, knowledge about comorbidities and their cumulative effect on outcomes is scarce. We retrospectively collected pretransplant comorbidities of all 513 adult recipients transplanted at our center between 1992–2019. Multiple logistic- and Cox regression models, adjusted for donor-, pre- and peri-operative variables, were used to detect independent risk factors for primary graft dysfunction grade-3 at 72 h (PGD3-T72), onset of chronic allograft dysfunction grade-3 (CLAD-3) and survival. An increasing comorbidity burden measured by Charleston-Deyo-Index was a multivariable risk for survival and PGD3-T72, but not for CLAD-3. Among comorbidities, congestive right heart failure or a mean pulmonary artery pressure >25 mmHg were independent risk factors for PGD3-T72 and survival, and a borderline risk for CLAD-3. Left heart failure, chronic atrial fibrillation, arterial hypertension, moderate liver disease, peptic ulcer disease, gastroesophageal reflux, diabetes with end organ damage, moderate to severe renal disease, osteoporosis, and diverticulosis were also independent risk factors for survival. For PGD3-T72, a BMI>30 kg/m2 was an additional independent risk. Epilepsy and a smoking history of the recipient of >20packyears are additional independent risk factors for CLAD-3. The comorbidity profile should therefore be closely considered for further clinical decision making in candidate selection.

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Morbidity and mortality of serious gastrointestinal complications after lung transplantation

Cited by 10 publications

References 20 publications

Management and Outcomes of Diverticulitis After Lung Transplantation

Management and Outcomes of Diverticulitis After Lung Transplantation

Effects of intraoperative fluid therapy on intensive care process, morbidity, and mortality after lung transplantation

Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation

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