Gastrointestinal disease following heart transplantation.

Details

Serval ID
serval:BIB_ED044FEF547B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Gastrointestinal disease following heart transplantation.
Journal
World journal of surgery
Author(s)
Mueller X.M., Tevaearai H.T., Stumpe F., Hurni M., Ruchat P., Fischer A.P., Seydoux C., Goy J.J., von Segesser L.K.
ISSN
0364-2313
Publication state
Published
Issued date
1999
Peer-reviewed
Oui
Volume
23
Number
7
Pages
650-5; discussion 655-6
Language
english
Notes
Publication types: Journal Article - Publication Status: ppublish
Abstract
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.
Keywords
Adolescent, Adult, Aged, Anal Canal, Appendectomy, Cholecystectomy, Colonic Diseases, Colostomy, Cyclosporine, Diverticulitis, Colonic, Duodenal Ulcer, Female, Follow-Up Studies, Gastrointestinal Diseases, Heart Transplantation, Hernia, Ventral, Humans, Iatrogenic Disease, Immunosuppressive Agents, Intestinal Fistula, Intestinal Perforation, Male, Middle Aged, Pancreatitis, Rectum, Risk Factors, Sigmoid Diseases, Urinary Bladder Fistula
Pubmed
Web of science
Create date
28/01/2008 10:11
Last modification date
20/08/2019 16:14
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