European Journal of Cardio-Thoracic Surgery, Vol 12, 718-723, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Incidence and outcome of major non-pulmonary surgical procedures in lung transplant recipients
T Wekerle, W Klepetko, W Wisser, O Senbaklavaci, O Artemiou, A Zuckermann and E Wolner
Department of Surgery, Vienna General Hospital, University of Vienna, Austria.
OBJECTIVE: Pulmonary transplant recipients are at high risk from various
conditions requiring surgical intervention. As little is known about their
exact incidence and course, we examined such procedures in detail. METHODS
AND PATIENTS: We have retrospectively analyzed major nonpulmonary surgical
procedures performed in 124 consecutive patients who received an isolated
lung transplant at the University of Vienna between 1989 and December 1995.
Twenty-two patients underwent a total of 28 major interventions (22/124 =
17.7%), resulting in an incidence of one procedure every 5.8 patient years
of follow-up. The mean interval between transplantation and intervention
was 17.9 months (range 3 days to 62 months) with six interventions being
carried out during the first month after transplantation. Fourteen
emergency operations were performed, the remaining 14 procedures were
carried out electively. Overall, 15 abdominal procedures, four thoracic,
four orthopedic, two gynecological, one neurosurgical, one urological and
one plastic surgery were performed. RESULTS: There was no intraoperative
death. Perioperatively, five surgery related deaths were observed (5/28,
related mortality 17.9%) with multiple organ failure as the cause of death
in all cases. All of these deaths followed emergency operations (5/14 =
35.7%) and all were observed in patients with septic abdominal
complications. In contrast, even very extensive procedures were performed
electively without related mortality (0/14, P = 0.02). During the first
month after transplantation, major surgery was associated with a 50% (3/6)
mortality, for late interventions mortality was 9.1% (2/22; P = 0.047).
CONCLUSIONS: Pulmonary transplant recipients showed a high incidence of
conditions requiring surgical intervention. As expected, septic
complications, especially during the immediate post transplant period,
carried a very poor prognosis. However, it was reassuring to observe that
even extensive surgical procedures could be performed safely without
associated mortality in the elective setting.
