Outcomes of microvascular flap reconstruction of the head and neck in patients receiving systemic immunosuppressive therapy for organ transplantation

Abstract

Major head and neck free flap reconstructive surgery can be performed safely in organ transplant patients receiving immunosuppressive therapy. Meticulous multidisciplinary care is required to achieve consistently successful outcomes.

Outcomes of head and neck surgery in patients with a history of solid organ transplantation

“…In a retrospective noncomparison study by Schaverien et al that evaluated the postoperative course of 25 organ recipients who underwent head and neck surgery with free flap reconstruction at the University of Texas M. D. Anderson Cancer Center observed no microvascular anastomotic thrombosis and no total flap losses or acute rejection episodes . Delayed wound healing was found in only 18.5% of the sample, and only one patient developed a wound infection . However, six patients in their cohort developed severe medical complications postoperatively that included acute respiratory failure, acute congestive heart failure, severe Clostridioides difficile infection, recurrent hypoglycemia, and encephalopathy syndrome .…”

“…Hospital LOS was not statistically different in the multivariate model that controlled for multiple factors including site and class of surgery. In a retrospective noncomparison study by Schaverien et al that evaluated the postoperative course of 25 organ recipients who underwent head and neck surgery with free flap reconstruction at the University of Texas M. D. Anderson Cancer Center observed no microvascular anastomotic thrombosis and no total flap losses or acute rejection episodes . Delayed wound healing was found in only 18.5% of the sample, and only one patient developed a wound infection .…”

“…Delayed wound healing was found in only 18.5% of the sample, and only one patient developed a wound infection . However, six patients in their cohort developed severe medical complications postoperatively that included acute respiratory failure, acute congestive heart failure, severe Clostridioides difficile infection, recurrent hypoglycemia, and encephalopathy syndrome . The lack of a comparison group prevents the assessment of the association of those complications with organ transplantation patients.…”

“…Organ donation, preservation, and transplantation are witnessing considerable progress on multiple fronts . The prevalence of patients with a transplanted organ is on the rise, made possible in part by advances in immunosuppressive therapy effectively delaying rejection and organ failure . The improvement in life expectancy of organ recipients is generating an expanding cohort of patients who are likely to present with medical conditions related or unrelated to their immunosuppression status …”

“…3,4 In otolaryngology, prolonged immunosuppression was found to increase the risk of cutaneous cancers, head and neck squamous cell carcinoma, and sarcoma. 2,5 Furthermore, organ recipients are more likely to exhibit a more severe and advanced disease course. 2,[5][6][7] Management of patients with a history of organ transplantation requires special considerations and a multidisciplinary approach.…”