Gastrointestinal complications after human transplantation and mechanical heart replacement

Villar, Hugo V.; Neal, David; Levinson, M.; Fuller, James Martin; Emery, Robert W.; Graham, Anna R.; Copeland, Janice A.; Rhenman, Mary Jean; Copeland, Jack G.

doi:10.1016/0002-9610(89)90441-8

Cited by 28 publications

(24 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The deleterious effects of steroids, azathioprine, and cyclosporine have been implicated in the predisposition to GI complications. [7][8][9]10,14 The same phenomena have been observed in renal transplantation patients in whom the rate of GI complications is also high. 7,13 In the presence of life-threatening GI complications, an immediate decrease in steroid dosage, and the cessation of azathioprine have been recommended, along with appropriate medical and prompt surgical therapy, as the critical therapeutic maneuvers to provide the maximal chance for survival.…”

Section: Discussionsupporting

confidence: 61%

“…[1][2][3][4][5][6][7][8][9][10][11] It has been suggested that gastrointestinal complications, that can be observed even in up to 45% of the patients, may be related to factors created by the specificity of cardiac transplantation. [1][2][3][4][5][6][7][8] First, acute cardiac dysfunction and low cardiac output during the early period following the operation may increase the risk of pancreatitis, gastrointestinal (GI) bleeding, or bowel ischemia. Second, obligatory immunosuppression provides an additional milieu for the development of serious GI complications.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] The gastrointestinal complications described in cardiac transplant patients are: esophagitis, gastroduodenal peptic disease (de novo ulcer occurrence, perforation), biliary tract diseases (cholelithiasis, cholecystitis, cholangitis), gastroenteritis, colon diverticulitis and perforation, appendictis, abdominal wall hernias, and pancreatitis. [1][2][3][4][5][6][7][8][9][10][11] Pancreatitis is found in from 2% to 18% of heart transplant patients 1-3,5-8,10-16 with a frequently fatal outcome. [1][2][3][4][6][7][8]12 This frequency is 15-25 times higher than after other cardiac procedures.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] Pancreatitis is found in from 2% to 18% of heart transplant patients 1-3,5-8,10-16 with a frequently fatal outcome. [1][2][3][4][6][7][8]12 This frequency is 15-25 times higher than after other cardiac procedures. 15,16 Moreover, due to its crypto-symptomatic course, pancreatitis is often not adequately diagnosed and therefore tends to be inappropriately treated, and thus it is not uncommonly reported as an unsuspected finding or cause of death at autopsy 1,2,12 in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pancreatitis Following Heart Transplantation: Report of a Case

et al. 2003

View full text Add to dashboard Cite

Serious complications involving the alimentary tract following cardiac transplantations are commonly reported, and may be associated with significant morbidity and mortality. One of the most serious gastrointestinal complications in such patients is acute pancreatitis. There is still little known concerning its pathogenesis, early diagnosis, and the most appropriate treatment for this clinical condition. Many authors have reported a high mortality caused by difficulties in making an accurate diagnosis resulting in the use of inappropriate therapy for so called crypto-symptomatic acute pancreatitis. The factor suspected to be responsible for the increased frequency of the gastroenterological diseases and for their masked onset seems to be immunosuppression, especially by corticosteroids. The case of a 46-year-old male patient with cardiac transplant, who, 3 years after the transplantation, developed mild acute pancreatitis, is presented. The immunosuppressive regimen he followed was based on cyclosporine. The acute pancreatitis was treated conservatively with a satisfactory outcome. In the course of the illness the patient developed a pancreatic pseudocyst that was managed successfully by percutaneous drainage. The patient is currently being followed up, and both his medical ailments and health-related quality of life are being monitored, while he continues to show mild symptoms of chronic pancreatitis.

show abstract

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pancreatitis Following Heart Transplantation: Report of a Case

et al. 2003

View full text Add to dashboard Cite

show abstract

“…While 83% of this group responded to oral antifungal agents, 17% died from septic complications. Candida esophagitis has also been demonstrated in 2% of heart and lung transplant recipients [13], with death occurring in one-third of such patients from sepsis.…”

Section: Discussionmentioning

confidence: 99%

Opportunistic upper gastrointestinal infection in transplant recipients

et al. 1995

View full text Add to dashboard Cite

Opportunistic infection of the upper gastrointestinal tract by cytomegalovirus (CMV) or invasive fungal infection was studied in 219 consecutive kidney and kidney/pancreas transplant recipients with regard to incidence, presentation, and clinical outcome. Prompt upper endoscopy was done in all patients with these symptoms: dyspepsia, dysphagia, or bleeding. Multiple biopsies were obtained for fungal culture, CMV culture, CMV assay, and histologic examination for fungal invasion. Between April 1991 and July 1993, 57/219 (26%) transplant patients developed upper gastrointestinal symptoms. At endoscopy, gross mucosal abnormality was evident in 48/57 (84%). Opportunistic infection was found in 21/48 (44%); however, CMV infection was also detected in 2/9 (22%) who had a normal study. Overall, CMV was present in 15/57 (26%) and invasive fungal infection in 8/57 (14%). All 23 infections were successfully eradicated. Opportunistic infection occurred in 12/31 (39%) with dyspepsia, 9/14 (64%) with dysphagia, and 2/12 (17%) with bleeding. Graft loss occurred in 5/23 (22%) with opportunistic infection vs 23/196 (12%) other recipients. Upper gastrointestinal symptoms are indicative of serious opportunistic infection in a significant number of transplant recipients. As opportunistic infection may jeopardize allograft function, all patients with upper gastrointestinal tract symptoms require prompt endoscopy and biopsy to effect appropriate therapy. Random biopsy is also recommended in the face of a normal endoscopic examination.

show abstract