Failure of abdominal wall closure after intestinal transplantation: Identifying high-risk recipients

Madeline R. Cloonan, Chaeli A. Fortina, David F. Mercer, Luciano M. Vargas, Wendy J. Grant, Alan N. Langnas, Shaheed Merani

Research output: Contribution to journalArticle

Abstract

Open abdomen and fascial dehiscence after intestinal transplantation increase morbidity. This study aims to identify recipient and donor factors associated with failure to achieve sustained primary closure (failed-SPC) of the abdomen after intestinal transplant. We conducted a single-center retrospective study of 96 intestinal transplants between 2013 and 2018. Thirty-eight (40%) were adult patients, and 58 were pediatric patients. Median age at transplantation was 36.0 and 5.8 years, respectively. Failed-SPC occurred in 31 (32%) patients. Identified risk factors of failed-SPC included preexisting enterocutaneous fistula (OR: 6.8, CI: 2.4-19.6, P =.0003), isolated intestinal graft (OR: 3.4, CI: 1.24-9.47, P =.02), male sex in adults (OR: 3.93, CI: 1.43-10.8, P =.009), and age over four years (OR: 6.22, CI: 1.7-22.7, P =.004). There was no association with primary diagnosis and prior transplant with failed-SPC. Donor-to-recipient size ratios did not predict failed-SPC. There was an association between failed-SPC and extended median hospital stay (100 vs 57 days, P =.007) and increased time to enteral autonomy in pediatric patients. There is a relationship between failed-SPC and a higher rate of laparotomy (OR: 21.4, CI: 2.78-178.2, P =.0003) and fistula formation posttransplant (OR: 11.4, CI: 2.83-45.84, P =.0005) in pediatric patients. Given inferior outcomes with failed-SPC, high-risk recipients require careful evaluation.

Original languageEnglish (US)
Article numbere13713
JournalClinical Transplantation
Volume33
Issue number11
DOIs
StatePublished - Nov 1 2019

Fingerprint

Abdominal Wall
Transplantation
Transplants
Pediatrics
Abdomen
Tissue Donors
Intestinal Fistula
Laparotomy
Small Intestine
Fistula
Length of Stay
Retrospective Studies
Morbidity

Keywords

  • clinical decision-making
  • complication: surgical/technical
  • intestinal transplantation
  • patient characteristics
  • recipient selection
  • surgical technique

ASJC Scopus subject areas

  • Transplantation

Cite this

Failure of abdominal wall closure after intestinal transplantation : Identifying high-risk recipients. / Cloonan, Madeline R.; Fortina, Chaeli A.; Mercer, David F.; Vargas, Luciano M.; Grant, Wendy J.; Langnas, Alan N.; Merani, Shaheed.

In: Clinical Transplantation, Vol. 33, No. 11, e13713, 01.11.2019.

Research output: Contribution to journalArticle

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abstract = "Open abdomen and fascial dehiscence after intestinal transplantation increase morbidity. This study aims to identify recipient and donor factors associated with failure to achieve sustained primary closure (failed-SPC) of the abdomen after intestinal transplant. We conducted a single-center retrospective study of 96 intestinal transplants between 2013 and 2018. Thirty-eight (40{\%}) were adult patients, and 58 were pediatric patients. Median age at transplantation was 36.0 and 5.8 years, respectively. Failed-SPC occurred in 31 (32{\%}) patients. Identified risk factors of failed-SPC included preexisting enterocutaneous fistula (OR: 6.8, CI: 2.4-19.6, P =.0003), isolated intestinal graft (OR: 3.4, CI: 1.24-9.47, P =.02), male sex in adults (OR: 3.93, CI: 1.43-10.8, P =.009), and age over four years (OR: 6.22, CI: 1.7-22.7, P =.004). There was no association with primary diagnosis and prior transplant with failed-SPC. Donor-to-recipient size ratios did not predict failed-SPC. There was an association between failed-SPC and extended median hospital stay (100 vs 57 days, P =.007) and increased time to enteral autonomy in pediatric patients. There is a relationship between failed-SPC and a higher rate of laparotomy (OR: 21.4, CI: 2.78-178.2, P =.0003) and fistula formation posttransplant (OR: 11.4, CI: 2.83-45.84, P =.0005) in pediatric patients. Given inferior outcomes with failed-SPC, high-risk recipients require careful evaluation.",
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