Division of Transplant, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Clin Transplant. 2019 Nov;33(11):e13713. doi: 10.1111/ctr.13713. Epub 2019 Oct 23.
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.
腹部开放和筋膜裂开是肠移植术后发病率增加的原因。本研究旨在确定与肠移植后未能实现腹部持续初次闭合（失败-SPC）相关的受者和供者因素。我们对 2013 年至 2018 年间进行的 96 例肠移植进行了单中心回顾性研究。其中 38 例（40%）为成人患者，58 例为儿科患者。移植时的中位年龄分别为 36.0 岁和 5.8 岁。31 例（32%）患者发生失败-SPC。失败-SPC 的确定危险因素包括：先前存在肠外瘘（OR：6.8，95%CI：2.4-19.6，P=.0003）、孤立的肠移植物（OR：3.4，95%CI：1.24-9.47，P=.02）、成人男性（OR：3.93，95%CI：1.43-10.8，P=.009）和年龄超过 4 岁（OR：6.22，95%CI：1.7-22.7，P=.004）。失败-SPC 与原发性诊断和既往移植无相关性。供受者体型比例不能预测失败-SPC。失败-SPC 与儿科患者延长的中位住院时间（100 天 vs 57 天，P=.007）和达到肠内自主的时间延长有关。失败-SPC 与儿科患者手术后剖腹术（OR：21.4，95%CI：2.78-178.2，P=.0003）和瘘形成（OR：11.4，95%CI：2.83-45.84，P=.0005）的发生率较高有关。鉴于失败-SPC 后的不良结果，高危受者需要仔细评估。
