Gastrointestinal Disease following Heart Transplantation

• Published in: World journal of surgery 1999-07, Vol.23 (7), p.650-656
• Main Authors: Mueller, Xavier M., Tevaearai, Hendrick T., Stumpe, Frank, Hurni, Michel, Ruchat, Patrick, Fischer, Adam P., Seydoux, Charles, Goy, Jean‐Jacques, von Segesser, Ludwig K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anal Canal - surgery; Appendectomy; Cholecystectomy; Colonic Diseases - etiology; Colonic Diseases - surgery; Colostomy; Cyclosporine; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Diverticulitis; Diverticulitis, Colonic - etiology; Diverticulitis, Colonic - surgery; Duodenal Ulcer; Duodenal Ulcer - etiology; Duodenal Ulcer - surgery; Female; Follow-Up Studies; Gastrointestinal Diseases - etiology; Heart Transplantation - adverse effects; Hernia, Ventral - etiology; Hernia, Ventral - surgery; Humans; Iatrogenic Disease; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Intestinal Fistula - etiology; Intestinal Fistula - surgery; Intestinal Perforation - etiology; Intestinal Perforation - surgery; Laparoscopic Cholecystectomy; Male; Middle Aged; Pancreatitis; Pancreatitis - etiology; Rectum - surgery; Risk Factors; Sigmoid Diseases - etiology; Sigmoid Diseases - surgery; Urinary Bladder Fistula - etiology; Urinary Bladder Fistula - surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/PL00012363

. 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.