Pavlidis ET, Katsanos G, Kofinas A, Tsoulfas G, Galanis IN, Pavlidis TE. Critical considerations for the management of acute abdomen in transplant patients. World J Transplant 2024; 14(2): 93944 [PMID: 38947966 DOI: 10.5500/wjt.v14.i2.93944]
Corresponding Author of This Article
Theodoros E Pavlidis, Doctor, PhD, Emeritus Professor, Surgeon, The 2nd Department of Propaedeutic Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Research Domain of This Article
Transplantation
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 18, 2024; 14(2): 93944 Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.93944
Critical considerations for the management of acute abdomen in transplant patients
Efstathios T Pavlidis, Georgios Katsanos, Athanasios Kofinas, Georgios Tsoulfas, Ioannis N Galanis, Theodoros E Pavlidis
Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis, The 2nd Department of Propaedeutic Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Georgios Katsanos, Athanasios Kofinas, Georgios Tsoulfas, Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54642, Greece
Author contributions: Pavlidis TE designed research, contributed new analytic tools, analyzed data, review and approved the paper; Galanis IN analyzed data, review and approved the paper; Pavlidis ET performed research, analyzed data, review and wrote the article; Tsoulfas G contributed new analytic tools, analyzed data, review and approved the paper; Katsanos G performed research, analyzed data and review; Kofinas A performed research, analyzed data and review.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros E Pavlidis, Doctor, PhD, Emeritus Professor, Surgeon, The 2nd Department of Propaedeutic Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Received: March 8, 2024 Revised: April 14, 2024 Accepted: April 26, 2024 Published online: June 18, 2024 Processing time: 98 Days and 0.6 Hours
Abstract
The number of solid organ transplantations performed annually is increasing and are increasing in the following order: Kidney, liver, heart, lung, pancreas, small bowel, and uterine transplants. However, the outcomes of transplants are improving (organ survival > 90% after the 1st year). Therefore, there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen. Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems. The perioperative regulation of immunosuppression, the treatment of accompanying problems of immunosuppression, the administration of cortisol and, above all, the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients. The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis, or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes. Immunosuppression in transplant patients is associated with the use of calcineurin inhibitors, corticosteroids, and antiproliferation agents. Many times, the clinical picture is atypical, resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality. Multidetector computed tomography is of utmost importance for early diagnosis and management. Transplant recipients are prone to infections, especially specific infections caused by cytomegalovirus and Clostridium difficile, and they are predisposed to intraoperative or postoperative complications that require great care and vigilance. It is necessary to follow evidence-based therapeutic protocols. Thus, it is required that the clinician choose the correct therapeutic plan for the patient (conservative, emergency open surgery or minimally invasive surgery, including laparoscopic or even robotic surgery).
Core Tip: Adequate caution should be taken with patients with acute abdomen after transplantation, and these patients need constant attention because of the altered clinical course of their disease due to existing immunosuppression. Computed tomography may be valuable in diagnosis. The management of these patients must be personalized, but urgent surgical intervention is commonly needed. Specific care must be applied during the perioperative period.
