Surgical Site Infections in the Early Posttransplant Period After Simultaneous Pancreas–Kidney Transplantation

Objective

This study evaluated the frequency of microbial isolates and their susceptibility profiles among cultures from the “surgical site” of 26 simultaneous pancreas-kidney (SPKT) recipients in the early posttransplant period.

Patients and Methods

Data on microbiologic cultures of 26 adult patients undergoing SPKT were collected prospectively from 2001 to the end of 2006. The isolation and identification of cultured micro-organisms was performed according to standard microbiological procedures and commercially available tests. Susceptibility of the strains to antibacterial agents was made by the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results

All patients were followed prospectively for the first 4 weeks after surgery yielding 168 microbial isolates from the surgical site. The most commonly isolated organisms were Gram-positive bacteria (65.5%) with domination of staphylococci (52.7%) as methicillin-resistant S aureus and methicillin-resistant coagulase-negative staphylococci. The second most common were enterococci (33.6%) with the presence of an high level aminoglycoside-resistant strains (64.9%) and vancomycin-resistant strains (2.7%). Gram-negative bacteria comprised 19% of positive cultures; among them were isolated extended spectrum beta-lactamase producers and carbapenem-resistant strains. Yeast-like fungi comprised 15.5% of positive cultures. In conclusion, we observed predominantly Gram-positive bacteria, comprising 65.5% of isolates. The increased proportion of multi-drug-resistant bacterial isolates may be due to the frequent prophylaxis of bacterial infections in patients.     

Urinary Tract Infections in the Early Posttransplant Period After Simultaneous Pancreas–Kidney Transplantation

Objective

Urinary tract infection (UTI) is among the common infection in simultaneous pancreas-kidney transplantation (SPKT).

Patients and Methods

The study included 26 adult patients undergoing SPKT between September 2001 and December 2006. All the patients were followed prospectively for UTI during the first 4 weeks after surgery. Urine samples were investigated for bacteriologic cultures. The micro-organisms were identified in accordance with standard bacteriologic procedures. Susceptibility testing was carried out using Clinical and Laboratory Standards Institute (CLSI) procedures.

Results

Among 77 urine specimens obtained from all recipients during the first month, there were 30 isolated bacterial strains. The most common were Gram-positive bacteria (53.3%) with predominance of enterococci (75%) associated with high levels of aminoglycoside resistant strains (HLAR; 58.3%) and vancomycin-resistant strains (VRE; 25%). Gram-negative bacteria were detected in 46.7% of positive cultures.

Conclusions

In our study, enterococci predominated as 75% of Gram-positive isolates. The increased proportion of multi-drug-resistant bacteria, which can caused severe UTI in patients after SPKT, may be due to the frequent use of prophylaxis of bacterial infections in patients.     

Influence of simultaneous pancreas and preemptive kidney transplantation on severity of postoperative complications

Background

Simultaneous pancreas and preemptive kidney transplantation (SPpreKT) seems to be the optimal treatment for the patients with diabetes type 1 who are progressing to end-stage renal disease. On the other hand, surgical complications with a high rate of relaparatomy are a limiting factor in pancreas transplantation.

Objective

Comparison of severity of surgical complications was performed between a group of preemptive (SPpreKT group) and nonpreemptive recipients of SPKT (SPKT group).

Methods

Between 1988 and 2010, we performed 112 SPKTs including 25 preemptive recipients (22.3%). The SPKT Group included 87 recipients (77.7%). The severity of complications was classified according to a modified Clavien scale: grade I, no complication; grade II, drug therapy; grade IIIA, invasive intervention not requiring general anesthesia; grade IIIB, invasive intervention requiring general anesthesia; grade IVA, graft failure; and grade IVB, death.

Results

Among the SPpreKT group, 64% of recipients were free from postoperative complications compared with 40.3% of the SPKT group (P < .01). Among the SPKT group, 52 recipients (59.7%) developed 58 postoperative complications, including 15 (17.3%) deaths due to graft pancreatitis (80%) or pancreatic fistula (20%). Among the SPpreKT group, 9 recipients developed 9 complications. None of the preemptively transplanted group subjects experienced a lethal complication. Among the SPpreKT group, the most severe complication was graft pancreatitis leading to graft removal in 2 recipients.

Conclusions

Recipients of preemptive SPKT developed significantly fewer postoperative complications, especially deaths. However the rates of mild (II, IIIA) and moderate (IIIB) complications as well as graft failures (IVA) were similar to the nonpreemptive group.     

Inadequate Blood Pressure Control in Most Kidney Transplant Recipients and Patients With Coronary Artery Disease With and Without Complications

Background

Hypertension is a widely accepted risk factor for coronary artery disease (CAD), chronic heart failure, and chronic kidney disease (CKD). In kidney transplant recipients, the prevalence of hypertension is 60% to 80%.

Objective

To assess the prevalence of target blood pressure in 2 high-risk populations: patients with CAD and kidney allograft recipients.

Patients and Methods

The study included 520 patients with CAD and 150 kidney allograft recipients. In the CAD population, 30% of patients had diabetes mellitus and 33% had CKD. In kidney allograft recipients, 52% had diabetes (15%) or CKD. Hypertension was diagnosed and treated in 72% of patients with CAD and 90% of kidney allograft recipients. In the CAD population without diabetes but with CKD, target blood pressure was achieved in 47% compared with 31% in the CKD population. Treatment included angiotensin-converting enzyme (ACE) inhibitors in 72% of patients, calcium channel blockers in 28%, diuretic agents in 27%, and β-blockers in 89%. In allograft recipients, more than 60% required 3 or more hypotension agents. Only 40% demonstrated target blood pressure. In the latter group, the most commonly used hypotension agents were ACE inhibitors in 38%, calcium channel blockers in 84%, diuretic agents in 51%, β-blockers in 68%, and α-blockers in 15%.

Conclusion

Both cohorts demonstrated a high prevalence of hypertension. Despite polytherapy, optimal blood pressure control was not achieved in most patients. Greater efforts should be expended to optimize blood pressure control, in particular in the presence of comorbidities. In transplant recipients, β-blockers are widely used, whereas ACE inhibitors are used infrequently.     

Neoplasm incidence in simultaneous pancreas and kidney transplantation: a single-center analysis

Background

Long-term immunosuppression is associated with an increased rate of cancer. The aim of this study was to analyze the incidence of newly diagnosed tumors in simultaneous kidney and pancreas transplantation (SPKT).

Methods

We retrospectively analyzed the incidence of a neoplasm among 360 diabetic subjects who consecutively underwent SPKT from 1985 to August 2010 in a single institution. Data were retrieved from the institutional registry. We evaluated the nature of all newly diagnosed malignant tumors, including posttransplantation lymphoproliferative disease (PTLD), to compare Kaplan-Meier survival rates with those of patients free of a neoplasm.

Results

The median follow-up was 8 years; the overall 5-year patient survival was 84%. In 25 patients the tumors were malignant. Almost one-fourth of the cancers represented skin tumors (3 squamous cell and 4 basal cell carcinomas). PTLD was diagnosed in 5 recipients. The cumulative survival of patients with malignancies was significantly lower than that in recipients without cancer (8-year survival by 38% vs 70%; P < .001). The mean (±SD) time to diagnosis was 6 ± 3 years. Since 2004, the 12 recipients with malignancy who were switched to sirolimus at the time of diagnosis showed survivals that were not apparently better than those who remained on the established immunosuppression (46% vs 55%; P = .71).

Conclusions

The risk of neoplasm development was similar to that reported by other centers. Recipients of SPKT show higher incidence of cancer, though their overall survival is still significantly better than in those usually remaining on dialysis.     

Urinary tract infections in the early posttransplant period after kidney transplantation: etiologic agents and their susceptibility

Objective

Urinary tract infection (UTI) is among the most common infections in solid organ transplantation, especially in kidney transplantation.

Patients and Methods

This study included 295 adult patients undergoing KTx between September 2001 and December 2007. All patients were followed prospectively for UTI during the first 4 weeks after surgery. Samples of urine were investigated by bacteriological cultures to identify microorganisms in accord with standard procedures. Susceptibility testing was performed using Clinical and Laboratory Standards Institute procedures.

Results

Urine specimens (n = 582) were obtained from 84.5% of 245 recipients during the first month after transplantation. Among the isolated bacterial strains (n = 291), the most common were Gram-negative bacteria (56.4%) predominantly Serratia marcescens (32.3%) and Enterobacter cloacae (14.6%). Extended- spectrum beta-lactamase (ESBL+) strains were isolated in 52.5% of cases. Gram-positive bacteria comprised 35.7%; most commonly, high-level aminoglycoside resistant (HLAR; 87.8%) and vancomycin-resistant (VRE; 11%) Enterococci. There were fungal strains in 23 cases (7.9%).

Conclusion

Our study showed predominantly Gram-negative rods from the Enterobacteriaceae family comprising (84.8%) of Gram-negative isolates: 52.5% ESBL and resistant enterococci (87.5%) in Gram-positive isolates. The increased proportion of isolates of multi-drug-resistant bacterial agents which can cause severe UTIs may be due to our frequent use of ceftriaxone for perioperative bacterial prophylaxis.     

Treatment With Ezetimibe in Kidney Transplant Recipients With Uncontrolled Dyslipidemia

Introduction

Cardiovascular disease is the leading cause of death in kidney transplant recipients. Hyperlipidemia is a cardiovascular risk factor present in over 70% of recipients. Ezetimibe has proved effective for the treatment of dyslipidemia in these patients.

Aim

To evaluate the efficacy and safety of treatment with ezetimibe in kidney transplant recipients with uncontrolled hyperlipidemia.

Materials and methods

We undertook a prospective study of 25 kidney transplant recipients with dyslipidemia who started treatment with 10 mg of ezetimibe. Statins were being taken by 96% of these patients. Monotherapy was used in one case. Measurements were made at baseline and after 3, 6, and 12 months of the lipid and hepatic profiles, CPK, lactose dehydrogenase, renal function and levels of immunosuppressive agents.

Results

A significant reduction was noted in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. No patient had changes in the hepatic profile, increased CPK and lactose dehydrogenase levels, or important adverse effects. Renal function remained stable, with no significant variations in plasma levels of the different immunosuppressive agents.

Conclusions

The use of ezetimibe associated with statins is an efficient and safe therapeutic alternative for the treatment of poorly controlled dyslipidemia in recipients of a kidney graft.     

Cardiovascular events after simultaneous pancreas-kidney transplantation

Objective

To retrospectively evaluate the incidence of cardiovascular events after functioning simultaneous pancreas-kidney transplantation (SPKT).

Patients and Methods

Cardiovascular events after 89 SPKT procedures performed at our institution from March 1995 to March 2009 were investigated. Study criteria included normal functioning of both grafts. Patients included 36 women and 53 men, with mean (range) age of 37.7 (25-66) years. Duration of diabetes mellitus was 23.6 (10-48) years, and of dialysis therapy was 19.8 (0-70) months. The exocrine pancreatic secretions were drained to the bladder in 41 patients, and enterically in 45 patients. Mean (SD) follow-up was 58.62 (34.74) months.

Results

During follow-up after SPKT, 9 patients (10.1%) experienced cardiovascular events including cerebrovascular accident in 4 patients, myocardial infarction (MI) in 3, and episodes of angina pectoris without evidence of coronary artery disease in 2 patients. Nevertheless, these two patients had sustained an MI that required coronary angioplasty before SPKT. Moreover, coronary angioplasty was required in 2 patients before they were enrolled in the transplantation program because of silent coronary artery disease. Four of 9 cardiovascular events occurred in the perioperative period. No deaths occurred due to cardiovascular events. Patient survival rate was 100%, with both grafts functioning in 87 (97.8%).

Conclusion

Cardiovascular events occur relatively frequently in patients undergoing SPKT. In the present study, most events occurred in the perioperative period, but did not result in death.     

Perforated appendicitis in children: is there a best treatment?

Purpose

This study was performed to provide outcome data for the development of evidenced-based management techniques for children with appendicitis in the authors’ hospital.

Methods

This is a retrospective analysis of 1,196 consecutive children with appendicitis over a 5-year period (1996 to 2001) at a metropolitan hospital.

Results

The median age was 9 years (7 months to 18 years). The perforation rate was 38.9%, and the nonappendicitis rate was 5.6%. Predictors of perforation included age less than 8 years, Hispanic ethnicity, generalized abdominal tenderness, rebound tenderness, and increased number of bands. In perforated cases, the median length of stay was 5 days, and the complication rate was 13.5%. There was no difference in complication rates related to type or timing of antibiotics or related to the individual surgeon. There was no difference in infection rates related to type of wound management.

Conclusions

Children with perforated appendicitis are treated effectively by a less expensive broad-spectrum antibiotic regimen, expeditious operation by open or laparoscopic technique, primary wound closure, and postoperative intravenous antibiotics until they are afebrile for 24 hours and have a white blood cell count of less than 12,000/mm³. This approach is to be used in our prospective, randomized analysis of children treated on or off a clinical pathway.     

Extended-release tacrolimus therapy in de novo kidney transplant recipients: single-center experience

Background

Available data for extended-release tacrolimus (Tac) except in clinical trials are limited.

Objective

To describe our initial experience with once-daily Tac in combination with corticosteroids and mycophenolate mofetil therapy in patients undergoing de novo renal transplantation.

Patients and Methods

In this retrospective, observational, single-center study, data were obtained for 49 adult recipients treated with extended-release Tac and 30 patients treated with standard-release Tac (control group). Mean (SD) follow-up in the 2 groups was 3.5 (2.5) months and 4.0 (2.6) months, respectively. The primary characteristics were comparable between the groups.

Results

The acute rejection rate in the extended-release group was 10%, and 13% in the standard-release group. Patient and graft survival rates were 98% and 96% vs 100% and 90%, respectively. Renal function in the 2 groups was comparable: serum creatinine concentration 1.3 (0.2) mg/dL vs 1.45 (0.4) mg/dL. At day 14 posttransplantation, Tac doses were 0.17 mg/kg/d vs 0.14 mg/kg/d, and blood concentrations were 9.0 ng/mL vs 14.0 ng/mL. In recipients older than 60 years, lower dosages of Tac resulted in blood concentrations similar to those in younger patients, with less variation in dosage.

Conclusions

Short-term experience with extended-release Tac therapy in de novo renal recipients confirms its efficacy and safety. Adjusting blood concentrations in the immediate posttransplantation period is less difficult with extended-release Tac compared with the twice-daily formulation.     

Multivariate Analysis of Risk Factors for Early Loss of Pancreas Grafts Among Simultaneous Pancreas-Kidney Transplants

To evaluate the risk factors for pancreas graft loss within 3 months postoperatively among 170 simultaneous pancreas-kidney transplantation (SPKT) we examined 38 variables.

Methods

Twenty-two variables were related to recipients; 12 to donors and 4 to the surgical procedure. In addition the latest follow-up dates as well as the transplant and/or death dates. Independent variables were examined with reference to the dependent pancreatic loss variable, excluding losses owing to deaths. Variables with statistical significance were analyzed to predict early graft loss.

Results

Univariate analyses determined the following significant variables: kidney cold ischemia time, older donors, non-white donors, death cause related to vascular disease, wound infection, and length of extended hospitalization. However, multivariate analysis showed that only donor age and kidney cold ischemia time were significant predictors for early pancreastic graft loss.

Conclusion

Donor age and kidney cold ischemia time were independently related to pancreatic loss after SPKT within 3 months posttransplantation.     

Safety of an Immunosuppressant Protocol Based on Sirolimus in Liver Transplant Recipients With Malignancies or High Risk of Tumor Recurrence

Background

The mammalian target of rapamycin inhibitors are immunosuppressive agents with antiproliferative effects and consequent potential application as anticancer agents. The safety and tolerance of calcineurin inhibitor (CNI)-free sirolimus-based immunosuppressant protocols in liver transplant recipients with malignancies or high risk of tumor recurrence has been scarcely evaluated.

Patients and methods

Fourteen liver transplant recipients, including 12 men, of overall mean age of 57.4 ± 12.4 years were distributed into two groups: group I, corresponding to 11 patients with malignant neoplasia, eight de novo neoplasia, and three recurrent hepatocarcinoma and; group II, three patients with high risk of tumor recurrence due to cholangiocarcinoma. Sirolimus was initiated at 2 mg od, with target levels of 3 to 9 ng/mL. Withdrawal of CNI was performed after reaching target levels of sirolimus. Periodic examinations of weight, arterial pressure, liver function tests, serum creatinine, triglycerides, cholesterol, sirolimus blood levels, and creatinine clearance were performed at 30, 60, 90, 180, and 360 days.

Results

After a median follow-up of 221.5 days, eight group I patients (72.7%) were alive, including six with stable disease. All group II patients were alive without evidence of tumor recurrence after a median follow-up of 560 days. CNI was withdrawn in 11 patients (78.6%). Sirolimus was withdrawn in only one case due to severe symptomatic oral ulcers. No vascular complications or rejection episodes were observed.

Conclusions

A sirolimus-based immunosuppressant protocol was well tolerated and safe in liver transplant recipients with malignancies or a high risk of recurrence of neoplastic disease.     

Molecular impact and inducible factors associated with adenovirus infection in hematopoietic stem [corrected] cell transplant patients

Background and Purpose of Study

Latent and active adenovirus infections are detected in 5% to 20% of hematopoietic stem cell transplant (HSCT) patients. In addition to the significant role of adenoviral infection in the pathogenesis of late-onset hemorrhagic cystitis in HSCT patients, adenovirus infections may have possible roles in undefined posttransplant clinical complications. Therefore, pre- and posttransplantation we studied the prevalence and role of adenoviral infections among HSCT clinical syndromes using molecular methods.

Materials and Methods

In this cross-sectional study between 2005 and 2008. We collected 470 EDTA-treated blood samples from 125 HSCT recipients, including 70 (56%) men and 55 (44%) women. The 52 (41.6%) HSCT patients underwent autologous grafts and the other 73 (58.4%), from related donors. One EDTA-treated blood sample was collected from all recipients pretransplantation. Also once per week for 3 months we were collected blood samples from HSCT patients to evaluate the prevalence of adenovirus DNA infection by a qualitative in house polymerase chain reaction method.

Results

The adenovirus genome was diagnosed in 2/75 (2.7%) HSCT patient samples pretransplantation. There were 28/395 (7.1%) plasma samples of transplant patients infected with adenovirus DNA. Graft-versus-host disease (GVHD) clinical complications were observed in six adenovirus-infected transplant recipients; there was a significant correlation between these viral infections and GVHD clinical presentation.

Conclusion

The high prevalence of adenovirus infection in HSCT recipients pre- and posttransplantation, was significantly related to GVHD symptoms, enforcing the important pathogenic role of these viral infections in clinical complications post-HSCT.     

Direct measurement of hepatic blood flow during living donor liver transplantation in children

Background

The changes in liver blood flow associated with living donor liver transplantation (LDLT) in children have not yet been studied. The aim of the present study was to investigate changes in hepatic hemodynamics before and after pediatric partial liver transplantation.

Methods

In 7 pediatric recipients with congenital cholestasis and native liver Child-Pugh classes B and C, portal vein flow (PVF) and hepatic arterial flow (HAF) were measured using an ultrasonic transit time flow meter before removal of the native liver and after transplantation and compared with donor left PVF and donor left HAF.

Results

The mean portal contribution to total hepatic blood flow was markedly decreased in the recipient native liver compared with that in the donor (69% ± 15% vs 32% ± 15%; P = .0003) and after reperfusion changed to almost the same ratio as that in the donor liver (73% ± 18%; P < .0001).

Conclusion

The extreme imbalance between PVF and HAF that is common in implanted partial liver in adult LDLT recipients was not observed in pediatric LDLT. After transplantation of an appropriately sized liver graft, the portal contribution to total liver blood flow normalized to the value for normal liver.     

Bacteriologic features of surgical site infections following breast surgery

Background

Perioperative antibiotic prophylaxis to prevent surgical site infections (SSIs) after breast surgery is common practice. Breast SSIs were investigated to determine bacterial isolates, resistance patterns, and the appropriateness of cefazolin, the authors' institution's current regimen for perioperative antibiotic prophylaxis.

Methods

A retrospective review of 53 patients with culture-positive breast SSIs between June 1997 and August 2008 identified patient characteristics, bacterial isolates, and microbial resistance patterns.

Results

Among the 53 patients with positive cultures, 42% (n = 22) had undergone mastectomy, and 34% (n = 18) had undergone lumpectomy. Sixty-three bacterial isolates were identified, with 15% of SSIs being polymicrobial. Of the isolates, 49% (n = 31) were gram-negative bacteria. There was only 1 case of methicillin-resistant Staphylococcus aureus. Eight of 63 (13%) gram-negative isolates were cefazolin resistant.

Conclusions

Gram-negative SSIs constituted half of the SSIs in this breast surgery cohort. Of all breast isolates, 17.5% were resistant to cefazolin. On the basis of these findings, antibiotic prophylaxis regimens alternative to cefazolin should be considered.     

Malignancy development in lung transplant patients

Introduction

The most common neoplasias among transplant patients are skin cancers and lymphoproliferative disorders.

Objective

To characterize lung transplanted recipients who developed malignancies.

Methods

A retrospective analysis of clinical records of our patients.

Results

Seven patients developed malignancies: skin cancer (n = 5; 71%), and adenocarcinomas of prostatic, gastric, and lung (n = 1 each). One patient developed two hematologic malignancies: T-cell lymphoma and multiple myeloma. Among five patients who died (71%), 3 were due to advanced neoplasia. The mean presentation time was 4.3 years. Skin cancers were resected. The patient with lung adenocarcinoma developed pleural involvement and died. The patient with T-cell lymphoma was treated, but succumbed afterward due to multiple myeloma. The patient with gastric adenocarcinoma died at 3 months after the diagnosis, and the patient with prostate cancer underwent surgery without disease recurrence.

Conclusion

Malignancies are a late complication of transplant recipients that require a prompt diagnosis and treatment to improve outcomes.     

Urinary tract infections in the early posttransplant period after liver transplantation: etiologic agents and their susceptibility

Background

We performed an analysis of etiologic agents for urinary tract infections in the early posttransplant period after orthotopic liver transplantation (OLT) in adult recipients.

Patients and Methods

The study covered the first 4 weeks after OLT of 190 patients from September 2001 to the end of 2007. Immunosuppression consisted of steroids and tacrolimus. Antimicrobial prophylaxis was piperacillin/tazobactam, fluconazole, and SBD. Urine samples were cultured to identify microorganisms in accord with standard microbiological procedures and to test susceptibility using Clinical Laboratory and Standards Institute guidelines.

Results

Urine specimens (n = 539) examined from 185 recipients (97.4%) showed 210 microbial strains. The most common were Gram-negative (n = 131; 62.4%) with predominance of Escherichia coli (28.2%), Enterobacter cloacae (19.1%), and Acinetobacter baumannii (11.4%). Extended-spectrum β- lactamases (ESBL(+)) strains were isolated in 38.5% of cases. Gram-positive bacteria comprised 28.6% (n = 60): The most common strains were enterococci (85% including HLAR 80.4% and VRE 17.6%] and staphylococci 11.8% [MRSA/MRCNS; 100%]. There were 19 (9%) fungal strains.

Conclusions

In general, the identification in urine samples of multi-drug-resistant bacterial and fungal strains in patients after OLT such as ESBL(+) 38.5%; HLAR 80.4%; VRE 17.6%; and MRSA/MRCNS 100% requires better infection control.     

Late gastrointestinal toxicities following radiation therapy for prostate cancer

Background

Radiation therapy is commonly used to treat localized prostate cancer; however, representative data regarding treatment-related toxicities compared with conservative management are sparse.

Objective

To evaluate gastrointestinal (GI) toxicities in men treated with either primary radiation or conservative management for T1-T2 prostate cancer.

Design, setting, and participants

We performed a population-based cohort study, using Medicare claims data linked to the Surveillance Epidemiology and End Results data. Competing risk models were used to evaluate the risks.

Measurements

GI toxicities requiring interventional procedures occurring at least 6 mo after cancer diagnosis.

Results and limitations

Among 41 737 patients in this study, 28 088 patients received radiation therapy. The most common GI toxicity was GI bleeding or ulceration. GI toxicity rates were 9.3 per 1000 person-years after three-dimensional conformal radiotherapy, 8.9 per 1000 person-years after intensity-modulated radiotherapy, 5.3 per 1000 person-years after brachytherapy alone, 20.1 per 1000 person-years after proton therapy, and 2.1 per 1000 person-years for conservative management patients. Radiation therapy is the most significant factor associated with an increased risk of GI toxicities (hazard ratio [HR]: 4.74; 95% confidence interval [CI], 3.97-5.66). Even after 5 yr, the radiation group continued to experience significantly higher rates of new GI toxicities than the conservative management group (HR: 3.01; 95% CI, 2.06-4.39). Because our cohort of patients were between 66 and 85 yr of age, these results may not be applicable to younger patients.

Conclusions

Patients treated with radiation therapy are more likely to have procedural interventions for GI toxicities than patients with conservative management, and the elevated risk persists beyond 5 yr.