Gastrointestinal disease following heart transplantation.
With advances in heart transplantation, a growing number of recipients are at risk of developing gastrointestinal disease. We reviewed our experience with gastrointestinal disease in 92 patients undergoing 93 heart transplants. All had follow-up, with the median time 4.8 years (range 0.5-9.6 years). During the period of the study we progressively adopted a policy of low immunosuppression aiming toward monotherapy with cyclosporine. Nineteen patients (20.6%) developed 28 diseases related to the gastrointestinal tract. Thirteen patients required 18 surgical interventions, five as emergencies: closure of a duodenal ulcer, five cholecystectomies (one with biliary tract drainage), a sigmoid resection for a diverticulitis with a colovesical fistula, a colostomy followed by a colostomy takedown for an iatrogenic colon perforation, appendectomy, two anorectal procedures, and six abdominal wall herniorrhaphies. At the onset of gastrointestinal disease, 8 patients were on standard triple-drug immunosuppression, all of them within 6 months of transplantation; 13 were on double-drug immunosuppression; and 7 were on cyclosporine alone. All the patients with perforations/fistulas were on steroids. Among the 11 infectious or potentially infectious diseases, 10 were on triple- or double-drug immunosuppression. One death, a patient who was on triple-drug immunosuppression, had a postmortem diagnosis of necrotic and hemorrhagic pancreatitis. Except for an incisional hernia following a laparoscopic cholecystectomy, there was no morbidity and, importantly, no septic complications. We concluded that a low immunosuppression policy is likely to be responsible for the low morbidity and mortality of posttransplant gastrointestinal disease, with a lower incidence of viscous perforation/fistula and infectious gastrointestinal disease.
Mueller
X M
XM
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
Tevaearai
H T
HT
Stumpe
F
F
Hurni
M
M
Ruchat
P
P
Fischer
A P
AP
Seydoux
C
C
Goy
J J
JJ
von Segesser
L K
LK
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D001062:Appendectomy; D002763:Cholecystectomy; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery; D003125:Colostomy; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004239:Diverticulitis, Colonic / Q000209:etiology / Q000601:surgery; D004381:Duodenal Ulcer / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000209:etiology*; D016027:Heart Transplantation / Q000009:adverse effects; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D012007:Rectum / Q000601:surgery; D012307:Risk Factors; D012810:Sigmoid Diseases / Q000209:etiology / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000209:etiology / Q000601:surgery
D007166:Immunosuppressive Agents; D016572:Cyclosporine