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Major Abdominal Complications Following Cardiac Transplantation

Major Abdominal Complications Following Cardiac Transplantation Abstract • Serious complications involving the alimentary tract are commonly reported following cardiac transplantation, and may be associated with significant morbidity and mortality. The aim of this report was to review the incidence, severity, and outcome of abdominal complications in our heart transplant population in whom we used corticosteroid-sparing protocols for immunosuppression. From March 1985 through September 1988, 178 patients underwent 185 cardiac transplants. Twenty-six cardiac transplant recipients (15%) sustained 33 major abdominal complications, including gastrointestinal bleeding (n = 8), pancreatitis (n = 8), bowel perforation (n = 6), cholecystitis (n = 4), and miscellaneous other problems (n=7). Operative therapy was required in 61% of cases. No deaths were caused by the gastrointestinal complications or their operative management. Corticosteroid-sparing immunosuppression may be responsible for the low incidence of abdominal morbidity, and early, aggressive surgical intervention may reduce subsequent mortality. (Arch Surg. 1989;124:889-894) References 1. Renlund DG, Bristow MR, Burton NA, Jones KW, Karwande SV, Gay WA. Survival following cardiac transplantation: what are acceptable standards? West J Med . 1987;146:627-630. 2. Melvin DB, Flege JB. Heart transplantation in Cincinnati . J Heart Transplant . 1986;6:48. 3. Modry DL, Kaye MP. Heart and heart-lung transplantation: the Canadian and world experience . Can J Surg . 1986;29:275-279. 4. Gilbert EM, Eiswirth CC, Renlund DG, et al. Use of Orthoclone OKT3 monoclonal antibody in cardiac transplantation: early experience with rejection prophylaxis and treatment of refractory rejection . Transplant Proc . 1987;19:45-53. 5. Dresdale AR, Drusin RE, Lamb J, Smith CR, Reemtsma K, Rose EA. Reduced infection in cardiac transplant patients . Circulation . 1985;72( (suppl 2) ):237-240. 6. Andreone PA, Olivari MT, Elick B, et al. Reduction of infectious complications following heart transplantation with triple-drug immunotherapy . J Heart Transplant . 1986;5:13-19. 7. Hofflin MJ, Potasman I, Baldwin JC, Oyer PE, Stinson EB, Remington JS. Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids . Ann Intern Med . 1987;106:209-216.Crossref 8. Colon R, Frazier OH, Kahan BD, et al. Complications in cardiac transplant patients requiring general surgery . Surgery . 1988;103:32-38. 9. DiSesa VJ, Kirkman RL, Tilney NL, Mudge GH, Collins JJ, Cohn LH. Management of general surgical complications following cardiac transplantation . Arch Surg . 1989;124:539-541.Crossref 10. Steed DL, Brown B, Reilly JJ, et al. General surgical complications in heart and heart-lung transplantation . Surgery . 1985;98:739-744. 11. Cooper DKC, Becerra EA, Novitazky D, Ozinsky J, Horak A, Reichart B. Surgery in patients with heart transplants: anesthetic and operative considerations . S Afr Med J . 1986;70:137-142. 12. Gay WA, O'Connell JG, Burton NA, Karwande SV, Renlund DG, Bristow MR. OKT3 monoclonal antibody in cardiac transplantation: experience with 102 patients . Ann Surg . 1988;208:287-290.Crossref 13. Renlund DG, O'Connell JB, Gilbert EM, Watson FS, Bristow MR. Feasibility of discontinuation of corticosteroid maintenance therapy in heart transplantation . JHeart Transplant . 1987;6:71-78. 14. Renlund DG, Bristow MR, Crandall BG, et al. Hypercholesterolemia after cardiac transplantation: amelioration by corticosteroid-free maintenance immunosuppression . J Heart Transplant . 1989;8:214-220. 15. Katz MR, Barnhart GR, Szentpetery S, et al. Reduction in adverse effects in cardiac transplant recipients with steroid free maintenance immunosuppression . J Heart Transplant . 1988;7:89. Abstract. 16. Gay WA. Cardiac transplantation: a surgical perspective . J Cardiothorac Anesth . 1988;2:513-518.Crossref 17. Renlund DG, O'Connell JB, Gilbert AM, et al. A prospective comparison of monoclonal CD-3 antibody (OKT3)-based rejection prophylaxis and equine antithymocyte globulin–based rejection prophylaxis in cardiac transplantation: decreased rejection and corticosteroid use with OKT3 . Transplantation . 1989;47:599-605.Crossref 18. Gilbert EM, Renlund DG, O'Connell JB, Eiswirth CC, Gay WA, Bristow MR. Immunosuppressive efficacy of vincristine in heart transplantation: a preliminary report . J Heart Transplant . 1987;6:369-374. 19. Messer J, Reitman D, Sacks HS, Smith H, Chalmers TC. Association of adrenocorticoid therapy and peptic ulcer disease . N Engl J Med . 1983;309:21-24.Crossref 20. Henry DA, Johnston A, Dobson A, Duggan J. Fatal peptic ulcer complications and the use of non-steroidal anti-inflammatory drugs, aspirin, and corticosteroids . Br J Med . 1987;295:1227-1229.Crossref 21. Sterioff S, Orringer MB, Cameron JL. Colon perforations associated with steroid therapy . Surgery . 1974;75:56-58. 22. Dayton MT, Kleckner SC, Brown DK. Peptic ulcer perforation associated with steroid use . Arch Surg . 1987;122:376-380.Crossref 23. Rigotti P, Van Buren CT, Payne WD, Peters C, Kahan BD. Gastrointestinal perforations in renal transplant recipients immunosuppressed with cyclosporine . World J Surg . 1986;10:137-141.Crossref 24. Faro RS, Corry RJ. Management of surgical gastrointestinal complications in renal transplant recipients . Arch Surg . 1979;114:310-312.Crossref 25. Julien PJ, Goldberg HI, Margulis AR, Belzer FO. Gastrointestinal complications following renal transplantation . Diagn Radiol . 1978;117:37-43. 26. Hubbard SG, Bivins BA, Lucas BA, Litvak AS. Acute abdomen in the transplant patient . Am Surg . 1980;46:116-120. 27. Owens ML, Wilson SE, Saltzman R, Gordon HE. Gastrointestinal complications after renal transplantation . Arch Surg . 1976;111:467-471.Crossref 28. Pollack MS, Short HD, Young JB, Piwinski SE, Callaway C, DeBakey ME. Graft stability in a heart transplant recipient whose immunosuppressive therapy was discontinued for 8 months . Transplantation . 1988;45:242-243.Crossref 29. Dahn MS, Whitcomb MP, Lange MP, Jacobs LA. Altered T-lymphocyte subsets in severe sepsis . Am Surg . 1988;54:450-455. 30. Stratta RJ, Warden GD, Ninneman JL, Saffle RJ. Immunologic parameters in burned patients: effect of therapeutic interventions . J Trauma . 1986;265:7-17.Crossref 31. Carney WP, Rubin RH, Hoffman RA, Hansen WP, Healey K, Hirsch MS. Analysis of T-lymphocyte subsets in cytomegalovirus mononucleosis . J Immunol . 1981;126:2114-2116. 32. Dafoe DC, Stoolman LM, Campbell DA, Lorber MI, Waskerwitz J, Turcotte JG. T cell subset patterns in cyclosporine-treated renal transplant recipients with primary cytomegalovirus disease . Transplantation . 1987; 43:452-454.Crossref 33. Sturdevant RAL, Singleton JW, Deren JJ, Law DH, McCleery JL. Pancreatitis in patients with Crohn's disease . Gastroenterology . 1979;77:883-891. 34. Broe PJ, Cameron JL. Azathioprine and acute pancreatitis: studies with an isolated perfused canine pancreas . J Surg Res . 1983;34:179-163.Crossref 35. Lorber MI, Van Buren CT, Flechner SM, Williams C, Kahan BD. Hepatobiliary and pancreatic complications of cyclosporine therapy in 466 renal transplant recipients . Transplantation . 1987;43:35-40.Crossref 36. Kahan BD, Flechner SM, Lorber MI, Golden D, Conley S, Van Buren CT. Complications of cyclosporine-prednisone immunosuppression in 402 renal allograft recipients exclusively followed at a single center for from one to five years . Transplantation . 1987;43:197-204.Crossref 37. Rotolo FS, Branum GD, Bowewers BA, Meyers WC. Effect of cyclosporine on bile secretion in rats . Am J Surg . 1986:151:35-40.Crossref 38. Aziz S, Bergdahl L, Baldwin JC, et al. Pancreatitis after cardiac and cardiopulmonary transplantation . Surgery . 1985;97:653-660. 39. Sinnnott JT, Cullison JP, Rogers K. Treatment of cytomegalovirus gastrointestinal ulceration in a heart transplant patient . J Heart Transplant . 1987;6:186-188. 40. Bramwell NH, Davies RA, Kosmal A, Tse GN, Keon WJ, Walley VM. Fatal gastrointestinal hemorrhage caused by cytomegalovirus duodenitis and ulceration after heart transplantation . J Heart Transplant . 1987;6:303-306. 41. Hoffus JM, Putasman J, Baldwin JC, Oyer PE, Stinson EB, Remington JS. Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroid . Ann Intern Med . 1987;106:209-216.Crossref 42. Krasna MJ, Flancbaum L, Trooskin SZ, et al. Gastrointestinal complications after cardiac surgery . Surgery . 1988;104:773-780. 43. Rosemurgy AS, McAllister E, Karl RC. The acute surgical abdomen after cardiac surgery involving extracorporeal circulation . Ann Surg . 1988;207:323-326.Crossref 44. Lettman IM, Paull DE, Barie PS, Isom OW, Shires GT. Intra-abdominal complications of cardiopulmonary bypass operations . Surg Gynecol Obstet . 1987;165:251-254. 45. Pinson CW, Alberty RE. General surgical complications after cardiopulmonary bypass surgery . Am J Surg . 1983;146:133-137.Crossref 46. Rose DM, Ranson JC, Cunningham JN, Spencer FC. Patterns of severe pancreatic injury following cardiopulmonary bypass . Ann Surg . 1984;199:168-172.Crossref 47. Chenoweth DE, Cooper SW, Hugh TE, Stewart RW, Blackstone EH, Kirklin JW. Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylotoxins . N Engl J Med . 1981;304:497-503.Crossref 48. Hanks JB, Curtis SE, Hanks BB, Andersen DK, Cox JL, Jones RC. Gastrointestinal complications after cardiopulmonary bypass . Surgery . 1982;92:394-400. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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References (56)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410080019002
Publisher site
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Abstract

Abstract • Serious complications involving the alimentary tract are commonly reported following cardiac transplantation, and may be associated with significant morbidity and mortality. The aim of this report was to review the incidence, severity, and outcome of abdominal complications in our heart transplant population in whom we used corticosteroid-sparing protocols for immunosuppression. From March 1985 through September 1988, 178 patients underwent 185 cardiac transplants. Twenty-six cardiac transplant recipients (15%) sustained 33 major abdominal complications, including gastrointestinal bleeding (n = 8), pancreatitis (n = 8), bowel perforation (n = 6), cholecystitis (n = 4), and miscellaneous other problems (n=7). Operative therapy was required in 61% of cases. No deaths were caused by the gastrointestinal complications or their operative management. Corticosteroid-sparing immunosuppression may be responsible for the low incidence of abdominal morbidity, and early, aggressive surgical intervention may reduce subsequent mortality. (Arch Surg. 1989;124:889-894) References 1. Renlund DG, Bristow MR, Burton NA, Jones KW, Karwande SV, Gay WA. Survival following cardiac transplantation: what are acceptable standards? West J Med . 1987;146:627-630. 2. Melvin DB, Flege JB. Heart transplantation in Cincinnati . J Heart Transplant . 1986;6:48. 3. Modry DL, Kaye MP. Heart and heart-lung transplantation: the Canadian and world experience . Can J Surg . 1986;29:275-279. 4. Gilbert EM, Eiswirth CC, Renlund DG, et al. Use of Orthoclone OKT3 monoclonal antibody in cardiac transplantation: early experience with rejection prophylaxis and treatment of refractory rejection . Transplant Proc . 1987;19:45-53. 5. Dresdale AR, Drusin RE, Lamb J, Smith CR, Reemtsma K, Rose EA. Reduced infection in cardiac transplant patients . Circulation . 1985;72( (suppl 2) ):237-240. 6. Andreone PA, Olivari MT, Elick B, et al. Reduction of infectious complications following heart transplantation with triple-drug immunotherapy . J Heart Transplant . 1986;5:13-19. 7. Hofflin MJ, Potasman I, Baldwin JC, Oyer PE, Stinson EB, Remington JS. Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids . Ann Intern Med . 1987;106:209-216.Crossref 8. Colon R, Frazier OH, Kahan BD, et al. Complications in cardiac transplant patients requiring general surgery . Surgery . 1988;103:32-38. 9. DiSesa VJ, Kirkman RL, Tilney NL, Mudge GH, Collins JJ, Cohn LH. Management of general surgical complications following cardiac transplantation . Arch Surg . 1989;124:539-541.Crossref 10. Steed DL, Brown B, Reilly JJ, et al. General surgical complications in heart and heart-lung transplantation . Surgery . 1985;98:739-744. 11. Cooper DKC, Becerra EA, Novitazky D, Ozinsky J, Horak A, Reichart B. Surgery in patients with heart transplants: anesthetic and operative considerations . S Afr Med J . 1986;70:137-142. 12. Gay WA, O'Connell JG, Burton NA, Karwande SV, Renlund DG, Bristow MR. OKT3 monoclonal antibody in cardiac transplantation: experience with 102 patients . Ann Surg . 1988;208:287-290.Crossref 13. Renlund DG, O'Connell JB, Gilbert EM, Watson FS, Bristow MR. Feasibility of discontinuation of corticosteroid maintenance therapy in heart transplantation . JHeart Transplant . 1987;6:71-78. 14. Renlund DG, Bristow MR, Crandall BG, et al. Hypercholesterolemia after cardiac transplantation: amelioration by corticosteroid-free maintenance immunosuppression . J Heart Transplant . 1989;8:214-220. 15. Katz MR, Barnhart GR, Szentpetery S, et al. Reduction in adverse effects in cardiac transplant recipients with steroid free maintenance immunosuppression . J Heart Transplant . 1988;7:89. Abstract. 16. Gay WA. Cardiac transplantation: a surgical perspective . J Cardiothorac Anesth . 1988;2:513-518.Crossref 17. Renlund DG, O'Connell JB, Gilbert AM, et al. A prospective comparison of monoclonal CD-3 antibody (OKT3)-based rejection prophylaxis and equine antithymocyte globulin–based rejection prophylaxis in cardiac transplantation: decreased rejection and corticosteroid use with OKT3 . Transplantation . 1989;47:599-605.Crossref 18. Gilbert EM, Renlund DG, O'Connell JB, Eiswirth CC, Gay WA, Bristow MR. Immunosuppressive efficacy of vincristine in heart transplantation: a preliminary report . J Heart Transplant . 1987;6:369-374. 19. Messer J, Reitman D, Sacks HS, Smith H, Chalmers TC. Association of adrenocorticoid therapy and peptic ulcer disease . N Engl J Med . 1983;309:21-24.Crossref 20. Henry DA, Johnston A, Dobson A, Duggan J. Fatal peptic ulcer complications and the use of non-steroidal anti-inflammatory drugs, aspirin, and corticosteroids . Br J Med . 1987;295:1227-1229.Crossref 21. Sterioff S, Orringer MB, Cameron JL. Colon perforations associated with steroid therapy . Surgery . 1974;75:56-58. 22. Dayton MT, Kleckner SC, Brown DK. Peptic ulcer perforation associated with steroid use . Arch Surg . 1987;122:376-380.Crossref 23. Rigotti P, Van Buren CT, Payne WD, Peters C, Kahan BD. Gastrointestinal perforations in renal transplant recipients immunosuppressed with cyclosporine . World J Surg . 1986;10:137-141.Crossref 24. Faro RS, Corry RJ. Management of surgical gastrointestinal complications in renal transplant recipients . Arch Surg . 1979;114:310-312.Crossref 25. Julien PJ, Goldberg HI, Margulis AR, Belzer FO. Gastrointestinal complications following renal transplantation . Diagn Radiol . 1978;117:37-43. 26. Hubbard SG, Bivins BA, Lucas BA, Litvak AS. Acute abdomen in the transplant patient . Am Surg . 1980;46:116-120. 27. Owens ML, Wilson SE, Saltzman R, Gordon HE. Gastrointestinal complications after renal transplantation . Arch Surg . 1976;111:467-471.Crossref 28. Pollack MS, Short HD, Young JB, Piwinski SE, Callaway C, DeBakey ME. Graft stability in a heart transplant recipient whose immunosuppressive therapy was discontinued for 8 months . Transplantation . 1988;45:242-243.Crossref 29. Dahn MS, Whitcomb MP, Lange MP, Jacobs LA. Altered T-lymphocyte subsets in severe sepsis . Am Surg . 1988;54:450-455. 30. Stratta RJ, Warden GD, Ninneman JL, Saffle RJ. Immunologic parameters in burned patients: effect of therapeutic interventions . J Trauma . 1986;265:7-17.Crossref 31. Carney WP, Rubin RH, Hoffman RA, Hansen WP, Healey K, Hirsch MS. Analysis of T-lymphocyte subsets in cytomegalovirus mononucleosis . J Immunol . 1981;126:2114-2116. 32. Dafoe DC, Stoolman LM, Campbell DA, Lorber MI, Waskerwitz J, Turcotte JG. T cell subset patterns in cyclosporine-treated renal transplant recipients with primary cytomegalovirus disease . Transplantation . 1987; 43:452-454.Crossref 33. Sturdevant RAL, Singleton JW, Deren JJ, Law DH, McCleery JL. Pancreatitis in patients with Crohn's disease . Gastroenterology . 1979;77:883-891. 34. Broe PJ, Cameron JL. Azathioprine and acute pancreatitis: studies with an isolated perfused canine pancreas . J Surg Res . 1983;34:179-163.Crossref 35. Lorber MI, Van Buren CT, Flechner SM, Williams C, Kahan BD. Hepatobiliary and pancreatic complications of cyclosporine therapy in 466 renal transplant recipients . Transplantation . 1987;43:35-40.Crossref 36. Kahan BD, Flechner SM, Lorber MI, Golden D, Conley S, Van Buren CT. Complications of cyclosporine-prednisone immunosuppression in 402 renal allograft recipients exclusively followed at a single center for from one to five years . Transplantation . 1987;43:197-204.Crossref 37. Rotolo FS, Branum GD, Bowewers BA, Meyers WC. Effect of cyclosporine on bile secretion in rats . Am J Surg . 1986:151:35-40.Crossref 38. Aziz S, Bergdahl L, Baldwin JC, et al. Pancreatitis after cardiac and cardiopulmonary transplantation . Surgery . 1985;97:653-660. 39. Sinnnott JT, Cullison JP, Rogers K. Treatment of cytomegalovirus gastrointestinal ulceration in a heart transplant patient . J Heart Transplant . 1987;6:186-188. 40. Bramwell NH, Davies RA, Kosmal A, Tse GN, Keon WJ, Walley VM. Fatal gastrointestinal hemorrhage caused by cytomegalovirus duodenitis and ulceration after heart transplantation . J Heart Transplant . 1987;6:303-306. 41. Hoffus JM, Putasman J, Baldwin JC, Oyer PE, Stinson EB, Remington JS. Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroid . Ann Intern Med . 1987;106:209-216.Crossref 42. Krasna MJ, Flancbaum L, Trooskin SZ, et al. Gastrointestinal complications after cardiac surgery . Surgery . 1988;104:773-780. 43. Rosemurgy AS, McAllister E, Karl RC. The acute surgical abdomen after cardiac surgery involving extracorporeal circulation . Ann Surg . 1988;207:323-326.Crossref 44. Lettman IM, Paull DE, Barie PS, Isom OW, Shires GT. Intra-abdominal complications of cardiopulmonary bypass operations . Surg Gynecol Obstet . 1987;165:251-254. 45. Pinson CW, Alberty RE. General surgical complications after cardiopulmonary bypass surgery . Am J Surg . 1983;146:133-137.Crossref 46. Rose DM, Ranson JC, Cunningham JN, Spencer FC. Patterns of severe pancreatic injury following cardiopulmonary bypass . Ann Surg . 1984;199:168-172.Crossref 47. Chenoweth DE, Cooper SW, Hugh TE, Stewart RW, Blackstone EH, Kirklin JW. Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylotoxins . N Engl J Med . 1981;304:497-503.Crossref 48. Hanks JB, Curtis SE, Hanks BB, Andersen DK, Cox JL, Jones RC. Gastrointestinal complications after cardiopulmonary bypass . Surgery . 1982;92:394-400.

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1989

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