Background As patients increasingly have undergone live transplantation (LT) and improved expected survival rate, there is a growing population of LT recipient undergoing elective surgery after LT. However, little has been reported about the types of this surgical procedure or clinical data of immunosuppression protocol during post-operative periods of elective surgery.

Methods We performed a retrospective study for the type of surgical procedure in 102 recipients who underwent major elective surgery following LT from May 1996 to Dec 2015 at a single institute. In addition, we collected the clinical data associated with immunosuppression during post-operative periods such as status of taking calcineurin inhibitor (CNI), duration of CNI discontinuation, history and number of acute cellular rejection within 3 months after elective surgery during post-operative periods, and trough level of CNI.

Results There were 19 cases of general surgery, 28 cases of orthopedic surgery, 43 cases of thoracic surgery, 6cases of urology surgery, 5 cases of gynecology surgery, and 2 cases of neurosurgery. Among 102 elective operations, video-assisted thoracoscopic surgery (VATS) was the most common type elective surgery. 33 recipients (32.3%) underwent VATS due to metastasis, infection so on. Median duration of CNI cessation after heart surgery was median 4 days, the longest duration in total type of elective surgery. We assigned patients to discontinuation group (DG) or continuation group according to status of taking CNI during surgery. DG were 24 recipients and CG were 56 recipients. 22 recipients were excluded due to no use of CNI for immunosuppression already before elective surgery. Recipients occurred biopsy proven acute cellular rejection (BPACR) within 3months after elective surgery were 2 patients (8.3%) versus 6 patients (10.7%) in CG versus DG, respectively (P=1.000). mean tacrolimus trough level were 7.2 ng/ml in CG and 8.6 ng/ml in DG (P=0.804).

Conclusions If the tacrolimus blood through level was properly maintained, temporary discontinuation during elective surgery in LT recipient was tolerable based on the prevalence of BPACR. Close monitoring for the tacrolimus through level is recommended for LT recipients undergoing surgery under general anesthesia.

CITATION INFORMATION: Cho C, Lee J, Kim K, Kim S, Lee J, Lee K, Kim J.-M, Choi G.-S, Kwon C, Joh J.-W. Type of Surgical Procedures and Clinical Significance of Calcineurin Inhibitor Temporary Discontinuation Regarding LT Recipients Undergoing Major Elective Surgery. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress