The management of acute appendicitis in liver transplant patients: How effective is the Alvarado score?

Abstract

OBJECTIVE:The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis.METHODS:The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed.RESULTS:In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 (range: 5-9). All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more.CONCLUSION:Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients.

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 ].…”

Liver transplant versus non-liver transplant patients underwent appendectomy with presumed diagnosis of acute appendicitis: Case Control Study

“…[5,8,9,11] The first publication regarding AAp in patients with LT was published in 2005 by Abt et al, [11] and since then, 14 articles have been published with one being a review article. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Our literature review with 33 LT patients who received appendectomy for AAp has been summarized in Table 3. The studies in the field show that AAp incidence in patients with LT ranges between 0.09%-0.67%.…”

Minimally Invasive Surgery Is Feasible in Patients with Liver and Kidney Transplantation

“…This was corroborated by the findings in our patients with acute appendicitis, who recovered uneventfully after early intervention. Without intention to use laparoscopic technique, even using reliable diagnosis by Alvarado score in transplant patients, the surgeon may encounter complicated appendicitis (perforated appendicitis, 2 out of 11 cases) at the time of surgical intervention [ 9 ].…”