Severe abdominal complications in patients subjected to cardiac transplantation: The problem of clinical inexpressiveness

Introduction. In transplanted patients, immunosupressive drugs can mask hab itual pathologies that impede their diagnoses and management. Abdominal pat hology gives up to 2-20%, 50% of which is surgical, with a mortality of 10- 40%. The most frequently detected pathologies are: acute pancreatitis, pept ic ulceration and intestinal obstruction. Objectives. To determine the alarm parameters, more adequate diagnostic pro cedures and the most frequent causes of morbidity and mortality in order to attempt to avoid them. Methods. In our center 225 heart transplantations were performed from May 1 984 to October 1997. The severe abdominal complications, time of appearance , implication of immunosupressive drugs and presence of rejection were stud ied in these patients. Results. 35 severe abdominal complications were detected (incidence 12,9%), with the majority differing (> 1 year following transplant). The most freq uently detected pathologies were digestive hemorrhages and perforations. Ac ute pancreatitis was 11%. The immunosupressive drugs used were prednisona, cyclosporin and azathioprine. In 12 out of 29 patients the abdominal compli cation was in the context of acute rejection. Conclusions. Even with some non-specific abdominal symptoms in these group of patients it is important to rule out severe pathologies such as acute pa ncreatitis or empty viscera perforation. The detection of amylases and lypa ses in the blood and an echographic or tomographic abdominal study should b e performed early with a digestive hemorrhage it is important to perform an endoscopy. If the surgical intervention seems imminent it's better to perf orm it without any delay, because it has been demonstrated that the delay i s worse than the probable rejection.