Abstract • Between February 1984 and May 1988, 55 patients underwent orthotopic cardiac transplantation at the Brigham and Women's Hospital, Boston, Mass. Basic immunosuppression was accomplished with steroid and cyclosporine therapies. Twelve patients suffered 14 major complications, including perforated ulcer in 3 patients; pancreatitis in 3 patients; pneumatosis coli in 2 patients; and cholecystitis, colonic necrosis, appendicitis, incarcerated umbilical hernia, pancreatic abscess, and toxic epidermal necrolysis in 1 patient each. Aggressive management of the patients included laparotomy in all but 2 patients with mild pancreatitis and the patient with toxic epidermal necrolysis, who was treated as a patient with a severe burn. In all of the patients, there was a resolution of these complications, except in one 59-year-old man with fatal hemorrhagic pancreatitis. Eleven of the 14 complications occurred during the initial hospitalization. The fatal case of pancreatitis was 1 of 5 (9%) operative mortalities in the entire series. Fifty operative survivors have been followed up for an average of 19 months, with four late deaths (8%) related to rejection. The actuarial probability of survival in patients discharged from the hospital was 90% at 12, 24, and 48 months. (Arch Surg. 1989;124:539-541) References 1. Penn I, Groth CG, Brettschneider L, Martin AJ Jr, Maarchioro TL, Starzl TE. Surgically correctable intra-abdominal complications before and after renal homotransplantation . Ann Surg . 1968;168:865-870.Crossref 2. Archibald ST, Jirsch DW, Bear RA. Gastrointestinal complications of renal transplantation, I: the upper gastrointestinal tract . CMA Journal . 1978;119:1291-1296. 3. Archibald SD, Jirsch DW, Bear RA. Gastrointestinal complications of renal transplantation, II: the colon . CMA Journal . 1978;119:1301-1314. 4. Powis SJA, Barnes AD, Dawson-Edwards P, Thompson H. Ileocolonic problems after cadaveric renal transplantation . Br Med J . 1972;1:99-101.Crossref 5. Thompson WM, Seigler HF, Rice RP. A complication following renal transplantation . AJR . 1975;125:723-730.Crossref 6. Guice K, Rattazzi LC, Marchioro TL. Colon perforation in renal transplant patients . Am J Surg . 1979;138:43-48.Crossref 7. Demling RH, Salvatierra O Jr, Belzer FO. Intestinal necrosis and perforation after renal transplant . Arch Surg . 1975;110:251-253.Crossref 8. Hadjiyannakis EJ, Samellie WAB, Evans DB, Calne RY. Gastrointestinal complications after renal transplantation . Lancet . 1971;2:781-784.Crossref 9. Adiseshiah M, Wells RC, Cory-Pearce R, Wallwork J, English TA. Acute pancreatitis after cardiac transplantation . World J Surg . 1983;7:519-521.Crossref 10. Oaks TE, Pennock JL, Myers JL, Wisman CB. Survival following a pancreatic abscess in a heart transplant recipient . J Heart Transplant . 1986;5:148-153. 11. Steed DL, Brown B, Reilly JJ, et al. General surgical complications in heart and heart-lung transplantation . Surgery . 1985;98:739-745. 12. Colon R, Frazier OH, Kahan BD, et al. Complications in cardiac transplant patients requiring general surgery . Surgery . 1988;103:32-38. 13. Hau T, VanHook EJ, Simmons RL, Najarian JS. Prognostic factors of peritoneal infections in transplant patients . Surgery . 1978;84:403-416. 14. Aziz S, Bergdahl L, Baldwin JC, et al. Pancreatitis after cardiac cardiopulmonary transplantation . Surgery . 1985;97:653-661. 15. Matolo NM, Garfinkle SE, Wolfman EF. Intestinal necrosis and perforation in patients receiving immunosuppressive drug . Am J Surg . 1976;132:753-754.Crossref 16. Warshaw AL. Acute perforation of the colon associated with chronic corticosteroid therapy . Am J Surg . 1976;131:442-446.Crossref 17. ReMine SG, Mcllrath DC. Bowel perforation in steroid-treated patients . Ann Surg . 1980;192:581-586.Crossref 18. Guillaume JC, Roujeau JC, Revuz J, Penso D, Touraine R. The culprit drugs in 87 cases of toxic epidermal necrolysis (Lyell's syndrome) . Arch Dermatol . 1987;123:1166-1170.Crossref 19. Nwokolo C, Byrne L, Misch KJ. Toxic epidermal necrolysis occurring during treatment with trimethoprim alone . Br Med J . 1988;296:970.Crossref 20. Revuz J, Penso D, Roujeau JC, et al. Toxic epidermal necrolysis. Clinical findings and prognosis factors in 87 patients . Arch Dermatol . 1987; 123:1160-1165.Crossref 21. Birchall N, Langdon R, Cuono C, Maguire J. Toxic epidermal necrolysis: an approach to management using cryopreserved allograft skin . J Am Acad Dermatol . 1987;16:368-372.Crossref 22. Heimbach DM, Engrav LH, Marvin JA, Harnar TJ, Grube BJ. Toxic epidermal necrolysis: a step forward in treatment . JAMA . 1987;257:2171-2175.Crossref
Archives of Surgery – American Medical Association
Published: May 1, 1989
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