Gastrointestinal disease following heart transplantation

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 transplan ts. 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 i mmunosuppression aiming toward monotherapy with cyclosporine. Nineteen pati ents (20.6%) developed 28 diseases related to the gastrointestinal tract. T hirteen patients required 18 surgical interventions, five as emergencies: c losure of a duodenal ulcer, five cholecystectomies (one with biliary tract drainage), a sigmoid resection for a diverticulitis with a colovesical fist ula, a colostomy followed by a colostomy takedown for an iatrogenic colon p erforation, appendectomy, two anorectal procedures, and six abdominal mall herniorrhaphies. At the onset of gastrointestinal disease, 8 patients were on standard triple-drug immunosuppression, all of them within 6 months of t ransplantation; 13 were on double-drug immunosuppression; and 7 were on cyc losporine alone. All the patients with perforations/fistulas were on steroi ds. Among the 11 infectious or potentially infectious diseases, 10 were on triple- or double-drug immunosuppression. One death, a patient who was on t riple-drug immunosuppression, had a postmortem diagnosis of necrotic and he morrhagic pancreatitis. Except for an incisional hernia following a laparos copic cholecystectomy, there was no morbidity and, importantly, no septic c omplications. We concluded that a low immunosuppression policy is likely to be responsible for the ion morbidity and mortality of posttransplant gastr ointestinal disease, with a lower incidence of viscous perforation/fistula and infectious gastrointestinal disease.