Acute appendicitis in organ transplantation patients: a report of two cases and a literature review.

Abstract

Abdominal surgery on patients with previous organ transplantation, especially in the early postoperative period, is a challenging problem. Due to high risk of complications in transplant patients, we usually tend to treat such patients more conservatively rather compared to the more aggressive attitude in diagnosis and surgery of non-transplant patients. Delayed diagnosis, delayed surgery, and high morbidity and mortality are more common in transplant patients with GI disease. While appendicitis is one of the most common surgical diseases, with an estimated lifetime risk of 8.6% for males and 6.7% for females, there are relatively few reports of appendicitis in solid organ transplant recipients, and the condition has rarely been reported after liver transplantation. We have performed surgery on 2 cases of presumed acute appendicitis among 75 cases of kidney and liver transplantation in our series in the last 10 years. Laparoscopic technique was used for exploration of presumed acute appendicitis with atypical clinical and image presentation in a deceased donor liver transplantation (DDLT) and a deceased donor kidney transplantation (DDKT). Acute appendicitis in both patients was highly suspected preoperatively in computed tomography, and early exploration with laparoscopic technique prompted early diagnosis and treatment, with excellent surgical outcomes.