Gastrointestinal complications after cardiac transplantation: potential benefit of early diagnoses and prompt surgical intervention

When emergency abdominal surgery is required following heart transplantation, death is quite frequent. A retrospective study was undertaken to determine the incidence of acute gastrointestinal complications following heart transplant, as well as their cause and severity. The potential impact of early diagnosis and possible surgery was also evaluated. During a seven-and-a-half-year period 151 patients underwent heart transplant, of whom 26 patients developed major gastrointestinal (GI) complications. The median age of these patients was 44. Of all incidences of rejection of the transplanted heart, 4 percent later developed GI complications. Forty-five percent (14 of 31 GI complications) occurred within the first month after transplant. The complications involved the pancreas (6), colon (6), stomach/small intestine (6), gallbladder (5), esophagus (3), appendix (2), hernia (2), and spleen (1). Symptoms of these conditions may be hidden by other conditions. Treatment for complications was medical for 17 patients, with two deaths; elective surgery for two patients; and emergency surgery for 12 patients, with three deaths. The average time from onset of symptoms to operation was 10 days. All patients operated on within three days of symptoms survived; two of the three patients who died had surgery delayed for more than 10 days. Overall morality for GI complications was 16 percent. It is suggested that careful monitoring for identification of early symptoms and prompt diagnostic evaluation and surgical intervention be carried out on patients requiring urgent surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)