GI COMPLICATIONS AFTER ORTHOTOPIC LUNG TRANSPLANTATION

Objectives: Recently, lung transplantation has been performed with inc reasing frequency and improved outcomes. GI complications have been ob served and reported in patients undergoing cardiac and renal transplan tations but only recently have been reported in patients after lung tr ansplantation. No large cohort has been systematically analyzed for al l GI complications after lung transplantation. The present study descr ibes, categorizes, and assesses risk factors for the development of su ch GI complications. Methods: Records of 45 patients who underwent 47 single or bilateral orthotopic lung transplants between November 1991 and January 1994 were reviewed. Results: Twenty-three patients (51%) h ad 64 GI complications requiring 13 operations on eight patients. The incidence of major abdominal procedures in the entire transplant cohor t was 18% (8/45), Their operative mortality rate was 63% (5/8). Eighte en different types of nonoperative complications occurred and were sub classified into major and minor complications. Complications were defi ned as major if they required medical or surgical intervention and alt ered patient management. Most GI complications (73%) occurred within 1 month after transplantation. No risk factors were identified to ascer tain who will develop GI complications. Conclusions: GI complications occur in more than one-half of lung transplant recipients early after transplantation and in the absence of identifiable risk factors. Becau se there are no precedent risk factors to suggest who will develop GI complications, clinicians must be alert to any warning signs and sympt oms. The majority of complications are nonoperative, responding to con servative therapy, but there is a higher overall mortality rate for pa tients requiring operative intervention, necessitating an aggressive s earch for major, life-threatening complications in these immunosuppres sed patients.