Gastroparesis after combined heart and lung transplantation.
OBJECTIVE
To determine the prevalence, severity, and outcome of gastroparesis after heart and lung transplantation (HLT).


METHODS
Ten patients (five women; age range, 27-57 years) underwent HLT at Temple University Hospital from 1996 to 1999. The charts of these patients were reviewed, including results from gastric emptying scans and upper endoscopies. Symptoms were assessed with a standardized questionnaire.


RESULTS
The indications for HLT included pulmonary hypertension in six patients, Eisenmenger syndrome in two, and dilated cardiomyopathy and congenital heart disease in two. Four patients died before the start of this clinical analysis. The six surviving patients constituted our study population. The patients' posttransplantation follow-up period ranged from 1.4 to 4.4 years (average, 2.6 years). Five patients (83%) were symptomatic with nausea, vomiting, and postprandial abdominal distension. Solid phase gastric emptying was delayed in all five patients with mean gastric retention of 93% at 2 hours (normal <50%). Patients generally did not respond to prokinetic agents. Four patients required pyloroplasty with J tube placement for symptom control, nutrition, and delivery of immunosuppressive medication.


CONCLUSIONS
There is a high prevalence of symptomatic gastroparesis in patients after HLT. The gastroparesis is severe and often resistant to prokinetic agents.
Sodhi
Sudeep S
SS
Gastroenterology Section, Department of Medicine and Nuclear Medicine Section, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Guo
Jin-Ping
JP
Maurer
Alan H
AH
O'Brien
Gerald
G
Srinivasan
Radhika
R
Parkman
Henry P
HP
D000328:Adult; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D018589:Gastroparesis / Q000453:epidemiology / Q000503:physiopathology*; D016041:Heart-Lung Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires