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Int J Angiol 2021; 30(02): 139-147
DOI: 10.1055/s-0041-1727137
Original Article

Colorectal Resection in Transplant Centers Benefits Kidney But Not Pancreas Transplant Recipients

Lauren Weaver 
1   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
,
Afshin Parsikia
2   Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Jorge Ortiz
3   Department of Surgery, Albany Medical Center, Albany, New York
› Author Affiliations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Abstract

As graft and patient survival rates improve, transplant recipients are likely to undergo colorectal surgery in their lifetime. Current literature on the surgical outcomes of colorectal resection in kidney and pancreas transplant recipients is sparse.

This investigation identifies areas of surgical risk for kidney, pancreas, and pancreas–kidney transplant recipients undergoing colorectal resection at transplant and teaching centers.

Multivariate logistic regression and linear regression tests computed odds ratios (OR) and coefficients of the linear regression using National Inpatient Sample data from 2005 to 2014 to identify differences in mortality, morbidity, length of stay (LOS), and total hospital charges among people with pancreas transplant alone (PTx), kidney transplant alone (KTx), pancreas and kidney transplant (PKTx), and nontransplant (non-Tx) undergoing colorectal resection in transplant and teaching centers.

Of the 2,737,454 individuals who underwent colorectal resection, 138 PTx, 3,874 KTx, 130 PKTx, and 2,733,312 non-Tx met the inclusion criteria. Overall KTx, PTx, and PKTx were not more likely to suffer a mortality. However, PTx were more likely to suffer a mortality in transplant and teaching centers. Overall, PTx and PKTx had significantly higher morbidity odds ratios (PTx OR: 2.268, p = 0.002; PKTx OR: 2.578, p < 0.001) along with longer LOS and higher total hospital charges. KTx incurred no increased morbidity risk in transplant centers.

Surgeons and transplant recipients should be aware of the increased morbidity and mortality risks when considering colorectal resection at different center types.

Keywords

colorectal resection - colectomy - transplant center - teaching center - kidney transplant - pancreas transplant

Author Contributions

LW, AP, and JO designed the study, contributed to the writing and editing, and data interpretation. AP acquired the data and performed the statistical analysis. All authors reviewed the study findings and read and approved the final version before submission.




Publication History

Article published online:
13 May 2021

© 2021. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Gruessner AC, Gruessner RW. Pancreas transplantation of US and non-US cases from 2005 to 2014 as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud 2016; 13 (01) 35-58
    CrossrefPubMedGoogle Scholar
  • 2 O'Connell PJ, Brown M, Chan TM. et al. The role of kidney transplantation as a component of integrated care for chronic kidney disease. Kidney Int Suppl 2020; 10 (01) e78-e85
    CrossrefPubMedGoogle Scholar
  • 3 Asghar F, Zhu H. Overview of pancreas transplantation. J Pancreas (Online) 2018; 19 (02) 65-69
    PubMedGoogle Scholar
  • 4 Wang JH, Skeans MA, Israni AK. Current status of kidney transplant outcomes: dying to survive. Adv Chronic Kidney Dis 2016; 23 (05) 281-286
    CrossrefPubMedGoogle Scholar
  • 5 Safaeian M, Robbins HA, Berndt SI, Lynch CF, Fraumeni Jr JF, Engels EA. Risk of colorectal cancer after solid organ transplantation in the United States. Am J Transplant 2016; 16 (03) 960-967
    CrossrefPubMedGoogle Scholar
  • 6 Sint Nicolaas J, de Jonge V, Steyerberg EW, Kuipers EJ, van Leerdam ME, Veldhuyzen-van Zanten SJ. Risk of colorectal carcinoma in post-liver transplant patients: a systematic review and meta-analysis. Am J Transplant 2010; 10 (04) 868-876
    CrossrefPubMedGoogle Scholar
  • 7 Johnson EE, Leverson GE, Pirsch JD, Heise CP. A 30-year analysis of colorectal adenocarcinoma in transplant recipients and proposal for altered screening. J Gastrointest Surg 2007; 11 (03) 272-279
    CrossrefPubMedGoogle Scholar
  • 8 Merchea A, Shahjehan F, Croome KP. et al. Colorectal cancer characteristics and outcomes after solid organ transplantation. J Oncol 2019; 2019: 5796108
    CrossrefPubMedGoogle Scholar
  • 9 Adami J, Gäbel H, Lindelöf B. et al. Cancer risk following organ transplantation: a nationwide cohort study in Sweden. Br J Cancer 2003; 89 (07) 1221-1227
    CrossrefPubMedGoogle Scholar
  • 10 Hwang SS, Cannom RR, Abbas MA, Etzioni D. Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Dis Colon Rectum 2010; 53 (12) 1699-1707
    CrossrefPubMedGoogle Scholar
  • 11 Qasabian RA, Meagher AP, Lee R, Dore GJ, Keogh A. Severe diverticulitis after heart, lung, and heart-lung transplantation. J Heart Lung Transplant 2004; 23 (07) 845-849
    CrossrefPubMedGoogle Scholar
  • 12 Khoury W, Lavery IC, Kiran RP. Effects of chronic immunosuppression on long-term oncologic outcomes for colorectal cancer patients undergoing surgery. Ann Surg 2011; 253 (02) 323-327
    CrossrefPubMedGoogle Scholar
  • 13 de'Angelis N, Esposito F, Memeo R. et al. Emergency abdominal surgery after solid organ transplantation: a systematic review. World J Emerg Surg 2016; 11 (01) 43
    CrossrefPubMedGoogle Scholar
  • 14 Sims SM, Kao AM, Spaniolas K. et al. Chronic immunosuppressant use in colorectal cancer patients worsens postoperative morbidity and mortality through septic complications in a propensity-matched analysis. Colorectal Dis 2019; 21 (02) 156-163
    CrossrefPubMedGoogle Scholar
  • 15 DiBrito SR, Alimi Y, Olorundare IO. et al. Outcomes following colorectal resection in kidney transplant recipients. J Gastrointest Surg 2018; 22 (09) 1603-1610
    CrossrefPubMedGoogle Scholar
  • 16 Kirchhoff SM. Medicare Coverage of End-Stage Renal Disease (ESRD). Congressional Research Service; 08-16-18 2018. R45290. https://fas.org/sgp/crs/misc/R45290.pdf
    Google Scholar
  • 17 Phurrough S, Salive M, Harrison S, Paserchia L, Lofton B. Decision Memorandum for Pancreas Transplants (CAG-00295R). 2006 https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=166&ver=19&NcaName=Pancreas+Transplants+
    Google Scholar
  • 18 Munasinghe A, Singh B, Mahmoud N. et al. Reduced perioperative death following laparoscopic colorectal resection: results of an international observational study. Surg Endosc 2015; 29 (12) 3628-3639
    CrossrefPubMedGoogle Scholar
  • 19 Mullen MG, Michaels AD, Mehaffey JH. et al. Risk associated with complications and mortality after urgent surgery vs elective and emergency surgery: implications for defining “quality” and reporting outcomes for urgent surgery. JAMA Surg 2017; 152 (08) 768-774
    CrossrefPubMedGoogle Scholar
  • 20 Tejiram S, Sava JA. Emergency General Surgery in the Immunocompromised Surgical Patient. In: Brown C, Inaba K, Martin M, Salim A. (eds) Emergency General Surgery. Springer, Cham; 2019. https://doi.org/10.1007/978-3-319-96286-3_42
    CrossrefGoogle Scholar
  • 21 Marcén R, Morales JM, Fernández-Rodriguez A. et al. Long-term graft function changes in kidney transplant recipients. NDT Plus 2010; 3 (02) (Suppl. 02) ii2-ii8
    PubMedGoogle Scholar
  • 22 Obrador GT, Macdougall IC. Effect of red cell transfusions on future kidney transplantation. Clin J Am Soc Nephrol 2013; 8 (05) 852-860
    CrossrefPubMedGoogle Scholar
  • 23 Handbook of Transfusion Medicine 5th Edition. In: Norfolk D. ed. United Kingdom: TSO; 2013. https://www.transfusionguidelines.org/transfusion-handbook . Accessed March 10, 2021
    Google Scholar
  • 24 Burke LG, Frakt AB, Khullar D, Orav EJ, Jha AK. Association between teaching status and mortality in US hospitals. JAMA 2017; 317 (20) 2105-2113
    CrossrefPubMedGoogle Scholar
  • 25 Khuri SF, Najjar SF, Daley J. et al; VA National Surgical Quality Improvement Program. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg 2001; 234 (03) 370-382 , discussion 382–383
    CrossrefPubMedGoogle Scholar
  • 26 (UNOS) UNfOS. Transplant Trends. 2019 https://unos.org/data/transplant-trends/ . Accessed March 10, 2021
    Google Scholar