Failure of abdominal wall closure after intestinal transplantation: Identifying high-risk recipients.
Abdominal Wall
/ physiopathology
Adult
Case-Control Studies
Child
Child, Preschool
Female
Follow-Up Studies
Graft Rejection
/ etiology
Graft Survival
Hernia, Abdominal
/ etiology
Humans
Intestines
/ transplantation
Male
Organ Transplantation
/ adverse effects
Postoperative Complications
/ etiology
Prognosis
Retrospective Studies
Risk Factors
Survival Rate
clinical decision-making
complication: surgical/technical
intestinal transplantation
patient characteristics
recipient selection
surgical technique
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
03
04
2019
revised:
30
08
2019
accepted:
09
09
2019
pubmed:
19
9
2019
medline:
24
9
2020
entrez:
19
9
2019
Statut:
ppublish
Résumé
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.
Types de publication
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13713Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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