ABDOMINAL OPERATIONS AFTER LUNG TRANSPLANTATION - INDICATIONS AND OUTCOME

Objective: To assess the outcomes of abdominal operations in patients with lung transplants and identify adverse risk factors. Design: Match ed cohort study. Setting: University referral center. Participants: Tw elve lung transplant recipients who required abdominal operations (her eafter referred to as case patients) and 12 age-, sex-, and pulmonary diagnosis-matched lung transplant recipients who had not undergone an abdominal procedure (hereafter referred to as control patients). Inter ventions: Elective abdominal operations including laparoscopic cholecy stectomies (n=5), laparoscopic repair of a colovaginal fistula (n=1), and open colectomy for a benign colovesical fistula (n=1) and urgent o perations including bowel resections (n=3), subtotal pan createctomy ( n=1), and hepatorrhaphy for an iatrogenic liver injury (n=1). Main Out come Measures: Morbidity and mortality. Results: Abdominal operations were performed in 12 (11%) of the patients undergoing lung transplanta tion at the university referral center since 1987, with an associated mortality rate of 25%. Morbidity and mortality rates of electively per formed procedures were 28% and 14%, respectively. An urgent indication for abdominal procedure was associated with 100% morbidity and 40% mo rtality. Compared with a matched group of 12 control patients, the lon g-term survival of the case patients was reduced (18% vs 64% at 4 year s). Case patients undergoing an abdominal procedure in the posttranspl antation period tended to have a higher prevalence of previous rejecti on (67% vs 25%), a higher perioperative steroid dosage (53 mg/d vs 36 mg/d), and a significantly lower posttransplantational forced expirato ry volume in 1 second (FEV1, 1.23 L vs 1.91 L; P<.05). Conclusions: El ective abdominal operations are relatively safe in properly prepared l ung transplant recipients. However, laparotomy for urgent surgical con ditions is associated with increased morbidity and mortality rates cau sed in part by the magnitude of the abdominal operation and influenced by the status of the lung transplant as manifested by previous reject ion episodes, perioperative steroid dosages, and FEV1 values.