Critical considerations for the management of acute abdomen in transplant patients  

作　　者：Efstathios T Pavlidis Georgios Katsanos Athanasios Kofinas Georgios Tsoulfas Ioannis N Galanis Theodoros E Pavlidis 

机构地区：[1]The 2^(nd)Department of Propaedeutic Surgery,Hippokration General Hospital,School of Medicine,Aristotle University of Thessaloniki,Thessaloniki 54642,Greece [2]Department of Transplantation Surgery,Center for Research and Innovation in Solid Organ Transplantation,Aristotle University of Thessaloniki,School of Medicine,Thessaloniki 54642,Greece

出　　处：《World Journal of Transplantation》2024年第2期8-12,共5页世界移植杂志

摘　　要：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 impro-ving(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 calci-neurin 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 tomo-graphy 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 intraop-erative 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

关 键 词：Acute abdomen Abdominal emergency surgery TRANSPLANTATION Immunocompromised patients IMMUNO-SUPPRESSION Posttransplantation surgery 

分 类 号：R657.3[医药卫生—外科学]