Abu-Elmagd, K

Altieri, KA

Funovits, M

Kovalak, JA

Miller, SR

Starzl, TE

Staschak-Chicko, SM

Todo, S

PubMed

D-Scholarship@Pitt

Hospitalization and Readmission of Intestinal Transplantation Recipients M. Funovits, S.R. Miller, JA Kovalak, KA Altieri, S.M. Staschak-Chicko, K. Abu-Elmagd, S. Todo, and T.E. Starzl CLINICAL trials of intestinal transplantation have been under way at the Pittsburgh Transplantation Unit since May 1990. The objective of this study was to determine the frequency and cause of hospital readmis-sions along with the composite length of stay in 28 con-secutive small bowel (SB) recipients. MATERIALS AND METHODS From May 1990 to December 1992.34 intestinal transplantations with or without extra-enteric organs were performed at our center. Of these. I adult patient died intraoperatively, 4 children died during initial hospitalization. and I child died 38 days after discharge. The remaining 28 patients. receiving S8 grafts (n:: 10). S8 and liver (S81L. n :: 14). or multivisceral grafts (MY. n :: 4). were discharged from the hospital. Sixteen patients were adults and 12 were children. Inclusion criteria included a minimum 6-month follow-up period after initial hospital discharge. Fol-low-up ranged from 8 to 35 months with a median follow-up of 14 months. The duration of initial hospitalization. along with the frequency. cause. and duration of each readmission. were ana-lyzed. RESULTS There was no significant difference between the adult and pediatric recipients regarding duration of initial transplant hospitalization. MV recipients were hospitalized longer (median. 21 weeks; range, 16 to 28 weeks), than the SB (median. IIA weeks; range, 5 to 28 weeks) or SB/L (median. lOA weeks; range, 7 to 22 weeks) recipients. Following initial discharge. all patients required I or more hospital readmissions. for a total of 163 readmissions during the follow-up period. Median frequency of readmis-sion for adults was 6.5 times for a total of 101 admissions. with a median duration of 7 days. Median frequency of readmission for children was 4.5 times for a total of 62 readmissions. and median duration was 8.5 days. The SBIL recipients were readmitted most frequently (median 6.5 times). while the SB recipients experienced the longest median duration per readmission (11.5 days). Opportunistic infections were the leading causes of readmission (52 of 163. 32%) of which line sepsis (35 of 52. 67%) and cytomegalovirus disease (CMV; 9 of 52. 17%) were the leading contributing factors. Dehydration from increased stomal output or diarrhea (without evidence of graft rejection or enteritis) occurred on 35 occasions C! 1%). but was easily treated by rehydration and dose adjustment of antidiarrheal agents. Readmission for treat-ment of allograft rejection was necessary on 26 occasions (16%). Fifteen readmissions (9%) were for routine fol-low-up to determine graft function and/or stomal closure. Reasons for the remaining 33 readmissions (20%). were highly variable. and included a number of iatrogenic com-TransplsntBtJOn Proceedings, Vol 26. No 3 (June). 1994: p 1419 plications as well as admissions for central catheter re-placement. Adults tended to have a higher readmission rate due to rejection (19% vs 11%) and CMV (9% vs 0%) than chil-dren. The pediatric recipients experienced more readmis-sions due to line sepsis (29% vs 17%) and dehydration episodes (27% vs 18%) than adults. The MV recipients experienced more frequent readmissions due to line sepsis and dehydration episodes than the SB or SBIL recipients. while all readmissions due to CMV disease were in the isolated SB group. Overall. rejection and dehydration readmission rates decreased over time and were lower after 12 months, while the frequency of readmissions due to infectious episodes remained problematic throughout the follow-up period. CONCLUSIONS Compared with other solid organ transplants. intestinal transplantation requires longer hospitalization after sur-gery and more frequent readmissions. The occurrence of intractable diarrhea and high stomal output have been particularly troublesome during the first 3 to 6 months after intestinal transplantation. I The SB recipients required fewer hospital readmissions. but the length of stay was much longer than that of composite graft recipients. pos-sibly due to persistent or recurrent CMV enteritis. 1.2 The MV recipients required frequent readmissions for manage-ment of line sepsis and dehydration episodes. most prob-ably due to prolonged intravenous nutritional support during graft adaptation. These results emphasize the difficulty and complexity of postoperative management of intestinal allograft recipi-ents. Successful intestinal transplantation depends on con-tinuous and careful clinical observation. along with early recognition and prompt treatment of potential postopera-tive complications. Comprehensive outpatient services are essential to reduce hospital readmissions and to ade-quately monitor and treat postoperative complications. REFERENCES I. Todo S. Tzakis A. Reyes J: Transplantation (in press) ~K Nakamura K. Nalesnik M. Jaffee R: Transplant Proc 25: 1212. 1993 From the Pittsburgh Transplantation Institute. University of Pitts-burgh Medical Center. Pittsburgh. Pennsylvania. Address repnnt requests to T.E. Starzl. MD. PhD. Pittsburgh Transplantation InstItute. University of Pittsburgh Medical Center. 3601 Fifth Avenue, Falk Clinic 5C. Pittsburgh. PA 15213. ~; 1994 by Appleton & Lange 0041-13451941$3.001 +0 1419 

Hospitalization and readmission of intestinal transplantation recipients

Name not available

http://d-scholarship.pitt.edu/5081/1/31735062126325.pdf

Hospitalization and readmission of intestinal transplantation recipients

Abstract

Similar works

Full text

Available Versions

D-Scholarship@Pitt

Name not available

Name not available