Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1990 May;211(5):538–542. doi: 10.1097/00000658-199005000-00003

Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention.

J K Kirklin 1, A Holm 1, J S Aldrete 1, C White 1, R C Bourge 1
PMCID: PMC1358218  PMID: 2339915

Abstract

Acute gastrointestinal (GI) illnesses are unusual but potentially fatal complications following cardiac transplantation. A retrospective study was performed to analyze the frequency, etiology, and severity of GI complications and the potential impact of early diagnosis and prompt surgical intervention when appropriate. Between 1981 and July 1, 1988, 31 GI complications (pancreatic, 6; colonic, 6; gastroduodenal, 6; biliary, 5; esophageal, 3; appendiceal, 2; hernia, 2; and splenic, 1) occurred in 26 patients undergoing 32 cardiac transplants. Complications were most common (14 of 31 patients, 45%) within the first 30 days after transplantation. Seventeen GI complications were treated medically (2 deaths), 2 with elective surgery and 12 with emergent operations (3 deaths). The overall mortality rate was 16%. All patients who underwent emergent operations within 3 days of onset of symptoms survived; the mean interval of onset between symptoms and operation in the nonsurvivors was 10 +/- 3.8 days. We infer that among patients requiring urgent surgical intervention, successful outcome is enhanced by intense surveillance for early symptoms, prompt diagnostic evaluation, and early surgical intervention.

Full text

PDF
538

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aldrete J. S., Sterling W. A., Hathaway B. M., Morgan J. M., Diethelm A. G. Gastrointestinal and hepatic complications affecting patients with renal allografts. Am J Surg. 1975 Feb;129(2):115–124. doi: 10.1016/0002-9610(75)90286-x. [DOI] [PubMed] [Google Scholar]
  2. Aranha G. V., Pickleman J., Pifarre R., Scanlon P. J., Gunnar R. M. The reasons for gastrointestinal consultation after cardiac surgery. Am Surg. 1984 Jun;50(6):301–304. [PubMed] [Google Scholar]
  3. Aziz S., Bergdahl L., Baldwin J. C., Weiss L. M., Jamieson S. W., Oyer P. E., Stinson E. B., Shumway N. E. Pancreatitis after cardiac and cardiopulmonary transplantation. Surgery. 1985 Jun;97(6):653–661. [PubMed] [Google Scholar]
  4. Bramwell N. H., Davies R. A., Koshal A., Tse G. N., Keon W. J., Walley V. M. Fatal gastrointestinal hemorrhage caused by cytomegalovirus duodenitis and ulceration after heart transplantation. J Heart Transplant. 1987 Sep-Oct;6(5):303–306. [PubMed] [Google Scholar]
  5. Briggs W. A., Hampers C. L., Merrill J. P., Hager E. B., Wilson R. E., Birtch A. G., Murray J. E. Aseptic necrosis in the femur after renal transplantation. Ann Surg. 1972 Feb;175(2):282–289. doi: 10.1097/00000658-197202000-00022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Broe P. J., Cameron J. L. Azathioprine and acute pancreatitis: studies with an isolated perfused canine pancreas. J Surg Res. 1983 Feb;34(2):159–163. doi: 10.1016/0022-4804(83)90055-0. [DOI] [PubMed] [Google Scholar]
  7. Corrodi P., Knoblauch M., Binswanger U., Schölzel E., Largiader F. Pancreatitis after renal transplantation. Gut. 1975 Apr;16(4):285–289. doi: 10.1136/gut.16.4.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Faro R. S., Corry R. J. Management of surgical gastrointestinal complications in renal transplant recipients. Arch Surg. 1979 Mar;114(3):310–312. doi: 10.1001/archsurg.1979.01370270080015. [DOI] [PubMed] [Google Scholar]
  9. Hubbard S. G., Bivins B. A., Lucas B. A., Litvak A. S. Acute abdomen in the transplant patient. Am Surg. 1980 Feb;46(2):116–120. [PubMed] [Google Scholar]
  10. Kahan B. D., van Buren C. T., Flechner S. M., Jarowenko M., Yasumura T., Rogers A. J., Yoshimura N., LeGrue S., Drath D., Kerman R. H. Clinical and experimental studies with cyclosporine in renal transplantation. Surgery. 1985 Feb;97(2):125–140. [PubMed] [Google Scholar]
  11. Merrell S. W., Ames S. A., Nelson E. W., Renlund D. G., Karwande S. V., Burton N. A., Sullivan J. J., Jones K. W., Gay W. A., Jr Major abdominal complications following cardiac transplantation. Utah Transplantation Affiliated Hospitals Cardiac Transplant Program. Arch Surg. 1989 Aug;124(8):889–894. doi: 10.1001/archsurg.1989.01410080019002. [DOI] [PubMed] [Google Scholar]
  12. Nghiem D. D., Corry R. J. Colorectal perforation in renal transplant recipients. Am Surg. 1983 Oct;49(10):554–557. [PubMed] [Google Scholar]
  13. Nogueira J. R., Freedman M. A. Acute pancreatitis as a complication of Imuran therapy in regional enteritis. Gastroenterology. 1972 May;62(5):1040–1041. [PubMed] [Google Scholar]
  14. Oaks T. E., Pennock J. L., Myers J. L., Wisman C. B. Survival following rupture of a pancreatic abscess in a heart transplant recipient. J Heart Transplant. 1986 Mar-Apr;5(2):148–153. [PubMed] [Google Scholar]
  15. Sinnott J. T., 4th, Cullison J. P., Rogers K. Treatment of cytomegalovirus gastrointestinal ulceration in a heart transplant patient. J Heart Transplant. 1987 May-Jun;6(3):186–188. [PubMed] [Google Scholar]
  16. Sinnott J. T., 4th, Cullison J. P., Rogers K. Treatment of cytomegalovirus gastrointestinal ulceration in a heart transplant patient. J Heart Transplant. 1987 May-Jun;6(3):186–188. [PubMed] [Google Scholar]
  17. Starzl T. E., Nalesnik M. A., Porter K. A., Ho M., Iwatsuki S., Griffith B. P., Rosenthal J. T., Hakala T. R., Shaw B. W., Jr, Hardesty R. L. Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin-steroid therapy. Lancet. 1984 Mar 17;1(8377):583–587. doi: 10.1016/s0140-6736(84)90994-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Steed D. L., Brown B., Reilly J. J., Peitzman A. B., Griffith B. P., Hardesty R. L., Webster M. W. General surgical complications in heart and heart-lung transplantation. Surgery. 1985 Oct;98(4):739–745. [PubMed] [Google Scholar]
  19. Tilney N. L., Collins J. J., Jr, Wilson R. E. Hemorrhagic pancreatitis. A fatal complication of renal transplantation. N Engl J Med. 1966 May 12;274(19):1051–1057. doi: 10.1056/NEJM196605122741903. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES