Type A Aortic Dissection Following Abdominal Solid Organ Transplantation: Population-Level Outcomes in the United States

Background

This study aims to analyze the patient characteristics, clinical outcomes, and contemporary trends concerning type A aortic dissection (TAAD) in previous recipients of abdominal solid organ transplantation (ASOT) in the United States.

Methods

The National Inpatient Sample was queried to identify all patients aged ≥18 with TAAD and a history of ASOT (TAAD-ASOT) between 2002 and 2015Q3 using ICD-9 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes were compared between TAAD-ASOT patients and TAAD patients without a history of ASOT (TAAD-non-ASOT).

Results

We identified a weighted total of 71 061 TAAD patients. Among them, 346 (0.49%) were ASOT recipients; of these, 318 (91.9%) were kidney transplant recipients, and 28 (8.1%) were liver transplant recipients. There is an increasing trend in the incidence of TAAD among ASOT recipients over the study period (p-trend < 0.001). Compared to TAAD-non-ASOT patients, TAAD-ASOT patients were younger (54.7 vs. 60.7 years, p < 0.001), less likely to be White (53.8% vs. 69.1%, p = 0.008), and associated with a higher Charlson Comorbidity Index (3.79 vs. 2.26, p < 0.001). TAAD-ASOT patients also exhibited significantly higher in-hospital mortality (27.4% vs. 17.8%, p = 0.03) and a greater risk of renal complications (53.5% vs. 29.7%, p < 0.001). Multivariable analysis indicated that a history of ASOT was independently associated with an increased in-hospital mortality rate in TAAD patients (adjusted odds ratio = 1.83, 95% CI = 1.01–3.31, p = 0.04).

Conclusions

TAAD-ASOT patients were younger but presented a higher comorbidity burden, an elevated in-hospital mortality rate, and an increased risk of postoperative complications compared to TAAD-non-ASOT patients. The rising incidence and unfavorable outcomes emphasize the need for future preventative measures and enhancements in surgical outcomes.