Acute Care Surgery on Kidney Transplant Recipients: Perspectives, Practices and Outcomes

With improved medical and surgical care, kidney transplant recipients (KTR) are living longer than ever before. When KTR require acute care (AC) surgery for non-transplant issues, it is unclear who should manage this unique population and what specific risks KTR face during the course of surgical care. To elucidate surgeon perspectives on acute care surgical management of transplant recipients, we designed and nationally administered a survey to transplant and AC surgeons. We then investigated the differences in mortality, morbidity, length of stay (LOS) and cost between KTR and non-transplant recipients (non-KTR) undergoing appendectomy, cholecystectomy and colorectal resection as a retrospective cohort study using data from the National Inpatient Sample and adjusting for patient and hospital level factors. There were 230 survey participants who were AC surgeons (response rate 14%) and 204 from transplant surgeons (response rate 20%). Both AC and transplant surgeons (78% and 100%) agreed that KTR care would be better at transplant centers, and that KTR requiring urgent surgery should be transferred to a transplant center if possible (80.2% and 87.2%). However, AC surgeons with more years of practice were less likely to transfer KTR to a transplant center (p = 0.03). In the national cohort study of appendectomy, complications were similar among KTR and non-KTR, while LOS and costs were greater for KTR (LOS ratio:1.31 95%CI 1.19-1.45; cost ratio: 1.17 95% CI 1.11-1.26). For cholecystectomy, KTR had higher mortality (2.7% vs 1.2%, p<0.001), morbidity (18.8% vs 13.9%, p<0.001; aOR 1.30 95%CI 1.12-1.51), LOS and costs (LOS ratio:1.23 95% CI 1.17-1.28; cost ratio:1.17 95%CI 1.08-1.31). For colorectal resection, KTR had higher mortality (11.1 vs 4.3%, p