Article: article from journal or magazin.
Gastrointestinal disease following heart transplantation.
World journal of surgery
650-5; discussion 655-6
Publication types: Journal Article - Publication Status: ppublish
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.
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
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