Editing Surgery in transplant patients


== Principles ==

* Immunosuppression is not a contraindication and good outcomes can still be achieved
* Contact transplant team before operating
* Common conditions can present atypically - rely on imaging
* Don't stop immunosuppression, but medications will need to be adjusted/managed

== Pre-op workup ==

* Assess graft function
** Kidney - urine output, ability to concentrate urine
** Liver - jaundice, pruritis, fluid retention
* Assess associated diseases
* Bloods
* Nutritional assessment
* Altered anatomy
* Immunosuppressants
** Azathioprine can be withheld for two days
** Mycophenolate can be withheld for 2-3 days or continued, and there is an IV alternative
** Cyclosporine can be given IV at 1/3 of usual dose
** Calcineurin inhibitors can be continued
** Sirolimus/everolimus - if elective, try and change to calcineurin inhibitor to allow wound healing
** Steroids

== Operative principles ==

* Careful tissue handling - risk due to immunosuppression
* Always be careful of altered ureter if present
* Consider prolonged antibiotics
* Consider stress dosing steroids

== Appendicitis ==

* Often appropriate to perform emergency surgery locally then transfer to a transplant list
* Obviously consult transplant centre up-front
* Can generally be done laparoscopically

== SBO ==

* Rarely have adhesions due to poor wound healing, so consider other causes

== PUD ==

* Manage as usual

== Biliary tree pathology ==

* Common, obviously if it is a liver transplant need to transfer

== Diverticulitis ==

* High rates of complication and mortality
* Consider elective resection even after one episode
* No anastomosis in emergency

[[Category:Transplant]]