GASTROINTESTINAL COMPLICATIONS AFTER ORTHOTOPIC CARDIAC TRANSPLANTATION

Objective and methods. A retrospective chart review was performed on a ll patients undergoing orthotopic cardiac allograft transplant at Oreg on Health Sciences University. Our purpose was to evaluate the inciden ce of gastrointestinal complications in these patients, and to assess the effect of immunosuppression.Results. From December, 1985, to June, 1994, 240 recipients underwent 250 orthotopic cardiac allograft trans plants at Oregon Health Sciences University with a 30 day mortality of 15 patients (6.3 +/- 3.0%). Of the 225 operative survivors, the follo w-up ranges from 1.0 month to 8.8 years with a mean of 39.9 +/- 1.9 mo nths. In our population of late survivors, 21 recipients (9.3%) have h ad gastrointestinal complications (GIC). Hepatobiliary (29%), peptic u lcer (14%), and pancreatic (14%) complications were the most prevalent . Surgical intervention was required in 19 patients (90%). Twelve proc edures (63%) were either emergently or urgently performed, and seven p rocedures (37%) carried out electively. Operative mortality was 33% in those patients with an emergent or urgent intervention. There was no operative mortality among those who had an elective procedure. Conclus ion. Maintenance prednisone dose was higher in patients with GIC than in those patients without GIC, 16.1 +/- 2.5 mg versus 7.3 +/- 0.2 mg ( P = 0.001), respectively. However, immunosuppression therapy for rejec tion episodes (i.e., Solumedrol megapulse or OKT3 therapy) was not rel ated to an increased incidence of GIC. We present a review of our 21 c ardiac transplant recipients to emphasize the potential for severe GIC and their corresponding perioperative morbidity and mortality.