Gastrointestinal Disease following Heart Transplantation |
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Authors: | Xavier M Mueller Hendrick T Tevaearai Frank Stumpe Michel Hurni Patrick Ruchat Adam P Fischer Charles Seydoux Jean-Jacques Goy Ludwig K von Segesser |
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Institution: | (1) Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, CH-1011 Lausanne, Switzerland, CH;(2) Department of Cardiology, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, CH-1011 Lausanne, Switzerland, CH |
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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. |
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