Association between diverticular disease requiring surgical intervention and mortality in the postlung transplant population - a retrospective cohort study

Severe Abdominal Complications in Lung Transplant Recipients

OBJECTIVES

Lung transplant is a complex procedure with potential for substantial postoperative complications, including abdominal issues. Although previous studies have suggested that preexisting gastrointestinal conditions may be associated with a high risk of posttransplant complications, the evidence remains inconsistent. We aimed to explore the incidence rates, risk factors, and outcomes of abdominal complications within the first year following lung transplant.

MATERIALS AND METHODS

We conducted a retrospective cohort study at the University Hospital Zurich of 68 lung transplant recipients who experienced abdominal complications within 1 year after transplant. Data were collected from medical records on baseline demographic and clinical characteristics, including pretransplant gastrointestinal and hepatobiliary diseases. We used descriptive statistics (Fisher exact test, chi-square test, and Cramer V test) to assess outcome details, such as the timing and type of abdominal complications, surgical interventions, and associations with pretransplant conditions.

RESULTS

Abdominal complications occurred at a mean of 43 days posttransplant, with bowel ischemia and perforation as the most common reasons for posttransplant surgical intervention. Symptoms leading to surgery included nausea and abdominal pain, and 1 of 8 patients with abdominal surgery (12.5%) died after surgery. Notably, no significant associations were found between pretransplant factors (ie, gastrointestinal disease, hepatobiliary disease, body mass index >24, smoking status, peripheral vascular disease, and diabetes) and the occurrence of posttransplant abdominal surgery. Effect size analyses indicated very weak associations, suggesting that these pretransplant conditions are not strong predictors of postoperative abdominal complications.

CONCLUSIONS

Our results showed that preexisting gastrointestinal and hepatobiliary conditions, along with other common pretransplant factors, were not significant predictors of abdominal complications following lung transplant. Future studies should focus on intraoperative and immediate postoperative factors and should explore the role of minimally invasive surgical techniques and potential benefits of earlier or more comprehensive pretransplant screening.

Management and Outcomes of Diverticulitis After Lung Transplantation

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.