The Operative Mortality in Renal Transplant and Dialysis Patient for End-Stage Renal Disease Undergoing Major Abdominal Surgery

Kim, Yong Gui; Park, Jung Il; Moon, In Sung; Koh, Yong Bok

Abstract

PURPOSE: There are steadily increasing number of patients with end-stage renal disease in dialysis and renal transplants. A few reports described the outcome of patients in dialysis those undergoing major abdominal surgery, but in renal transplants such a report has not been reported.
METHODS
We reviewed 43 patients who underwent major abdominal surgery including 22 patients undergoing dialysis (dialysis group), 7 patients undergoing dialysis with rejected renal transplants (rejected group), and 14 renal transplant with graft function (transplanted group).
RESULTS
Emergency operation was performed in 24 (55.8%) patients : 12 in dialysis group, 5 in rejected group, and 7 in transplanted group, The indication of surgery included malignant disease in 16 (37.2%), bowel perforation in 9 (20.9%), adhesive ileus in 5 (11.6%), gastrointestinal bleeding in 4 (9.3%) and etc. The operative mortality rate was 25.6% (11/43) and developed all in emergency surgery including 2 in dialysis group (9.1% : 2/22), 4 in rejected group (57.1% : 4/11), and 5 in transplanted group (35.7% : 5/14). The most common diseases in operative mortality cases were bowel perforation in 4 and gastrointestinal bleeding in 3, The cause of death were sepsis in 5, and, pneumonia, heart failure, and disseminated intravascular coagulation in 2, respectively.
CONCLUSION
The emergency major abdominal surgery in patients with renal transplantation and with rejected renal transplantation patients has high operative mortality rates than that of dialysis patients.