Colon and rectal complications after heart and lung transplantation.
BACKGROUND
Gastrointestinal complications of solid organ transplantation have been well described, but little attention has been paid to colorectal disorders in particular. The purpose of this study was to identify the incidence and severity of colorectal complications among a large cohort of heart and lung transplant recipients.


METHODS
We reviewed the medical records of heart, lung, and heart-lung transplant recipients at a single institution between 1978 and 2004. Complications were identified based on need for consultation, endoscopy, or operation by a colorectal surgeon after transplantation.


RESULTS
Of 1,012 patients who received transplantations (530 heart, 435 lung, 47 heart-lung), 56 patients (6%) required evaluation for 84 colorectal problems. Incidence of complications was 7% in lung transplant recipients, 6% in heart-lung transplant recipients, and 4% in heart transplant recipients. Forty-four events (52%) were considered major (diverticulitis, perforation, malignancy, and other) and 40 (48%) were minor (polyps, pseudo-obstruction treated medically or endoscopically, benign anorectal disease, and other). Twenty-three (27%) required colectomy and 9 (10%) necessitated anal operation. Thirty-six (43%) required less-invasive interventions (endoscopy, minor anorectal procedures, and other). Eighteen (21%) were treated with medical therapy alone. Six patients died from colorectal disease (7%).


CONCLUSIONS
Colorectal complications are a considerable source of morbidity and mortality after heart and lung transplantation. These complications occur more frequently in patients who undergo lung and heart-lung transplantation as compared with heart transplantation alone.
Goldberg
Hilary J
HJ
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Minnesota, Minneapolis, USA.
Hertz
Marshall I
MI
Ricciardi
Rocco
R
Madoff
Robert D
RD
Baxter
Nancy N
NN
Bullard
Kelli M
KM
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003108:Colonic Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index