Abdominal Aortic Aneurysms in Transplant Patients

Abstract

Physicians who manage aortic and iliac aneurysms will see increasing numbers of posttransplant patients present to the practice. Although the data is limited, there is a general agreement that aneurysm disease in transplant patients has a more aggressive course. Presumably, this is related to the long-term management of these patients on potent immunosuppressive medications. Preheart transplant patients with a history of ischemic cardiomyopathy should likely be screened for aortic aneurysms. Aortic aneurysms should be repaired in transplant patients when they are 5 cm in diameter, and iliac aneurysms should be repaired when they reach 3 cm. It is important to maintain transplant patients on their immunosuppressive medications throughout the perioperative period, though the potent immunosuppressant medication rapamycin requires special management. Patients with complicated postoperative courses should have their immunosuppression titrated accordingly, and a transplant physician should be involved in patient management. There are a few specific technical considerations for aneurysm repair in a previous heart and lung transplant recipient. If a liver transplant recipient requires an open aneurysm repair, the surgeon should be aware of the potential presence of an aortic conduit providing arterial inflow to the liver. When possible, pancreas and kidney transplant recipients should be most easily managed by an endovascular approach. If this is not possible, secondary to anatomic suitability then special consideration may be necessary to minimize the risk of postaneurysm repair organ failure.