Post-cardiac transplantation gout: Incidence of therapeutic complications

Objective: To study the clinical impact of gout treatment following cardiac transplantation. Methods: We performed an audit of all cardiac transplant recipients of the Alfred Hospital before August 1998 who lived in Victoria. Results: We studied 225 patients (81% men), with a mean post-transplant fol low-up of 50.8 months (SD 36), Forty-three (19%) had pre-transplant gout, 1 9 recurring posttransplantation. Twenty-three patients developed gout de no vo. Of the 24 patients who received allopurinol, 6 developed pancytopenia and r equired hospitalization. Fourteen received a change in immunosuppression: i n 5 patients following pancytopenia, and in 9 to enable safe use of allopur inol. Thirty-two patients received colchicine; 5 developed neuromyopathy. I mpaired renal function, diuretic use, and hypertension were more common in this sub-group. Non-steroidal antiinflammatory agents, used in 16 patients, caused serious complications in 1 patient (life-threatening peptic ulcerat ion and hemorrhage, precipitating dialysis-dependent chronic renal failure) . Conclusions: Cardiac transplant recipients, when treated for gout, are at h igh risk of therapeutic complications. Thus, gout treatment significantly a ffects care, health, and immunosuppression of these patients.