Gastrointestinal complications after pediatric cardiac transplantation

Abstract

Background: The incidence of major gastrointestinal complications after pediatric heart transplantation has not been well characterized. Studies in adults suggest significant morbidity and mortality from post-transplant gastrointestinal complications. In this study, we investigated major gastrointestinal complications in the pediatric heart transplant population. Methods: We performed a retrospective analysis of all patients who underwent heart transplantation at Children’s Hospital, Boston, including all pertinent clinical, radiologic, endoscopic, and pathologic findings. Between May 1986 and December 2000, 104 patients underwent 105 orthotopic heart transplantations. Gastrointestinal complications were defined as major if they significantly prolonged hospital course, required hospital admission, or required surgical intervention. Results: Median age at transplant was 8.7 years (range, 2 weeks to 23 years). Median duration of follow-up was 3.3 years (range, 2 days to 14.9 years). All patients initially received standard triple immunosuppression with cyclosporine, prednisone, and azathioprine. During this period, 30 major complication episodes occurred in 19 patients (18%) and included pancreatitis (7), cholecystitis (6), recurrent abdominal infection (5), malignancy (4), intestinal pneumatosis (4), colonic perforation (2), appendicitis (1), Crohn’s disease (1), and partial small bowel obstruction (1). Ten (53%) of the 19 patients with major gastrointestinal complications required surgical intervention. Conclusions: Serious gastrointestinal complications can occur after pediatric cardiac transplantation, with an incidence similar to that seen in adults. Gastrointestinal symptoms should be aggressively evaluated in the pediatric heart transplant patient because of the high incidence of complications that may require surgery.