J. Kaplan1, M. Lin1, H. Chern1, J. Yoo2, J. Reza3, A. Sarin1 1University Of California – San Francisco,Surgery,San Francisco, CA, USA 2University Of California – San Francisco,School Of Medicine,San Francisco, CA, USA 3University Of California – San Francisco,Anesthesiology,San Francisco, CALIFORNIA, USA
Introduction: Solid organ transplant recipients comprise a unique group of patients due to their surgical history, medical comorbidities, and immunosuppressed state. The purpose of this study is to describe the early postoperative outcomes of abdominal colorectal operations in solid organ transplant recipients at an academic medical center.
Methods: A retrospective review was performed of all patients who underwent an abdominal operation on the colon or rectum after solid organ transplantation at a single tertiary medical center between 2000 and 2014. Information regarding demographics, comorbidities, medications at the time of surgery, indications, operative details and 30-day outcomes were recorded.
Results: 2539 patients underwent abdominal solid organ transplant between 2000 and 2014, of which 50 patients were identified that underwent 58 colorectal procedures following the transplant. The median age at colorectal surgery was 55 years and median time from transplantation to colon surgery was 4 years. The most common indication for colon surgery was diverticular disease with most patients having received a kidney, liver or lung. In this series, 45% of cases were performed emergently. Patients undergoing emergent operations were closer to the time of transplant (median time 11 months vs. 7 years, p=0.01) and were less likely to undergo primary anastomosis (7.7% vs. 84.4%, p<0.001). Overall, median length of stay was 8 days and the rate of anastomotic leak was 10% in patients with a primary anastomosis. The 30-day readmission rate was 35% and 30-day mortality rate 3.5%. Emergent surgery was associated with 7.9 times the odds of severe complications (95% CI 1.2-11.9, p<0.05).
Conclusion: Rarely do solid organ transplant patients require colorectal surgery. Though surgery in this cohort can be safely performed in tertiary medical centers, morbidity and readmission rates are high. Emergent surgery is a key negative predictor of adverse events. Transplant patients with known colorectal disease may benefit from earlier elective procedures to prevent the poor outcomes associated with emergent surgery.
