Gastrointestinal complications following orthotopic lung transplantation

Abstract

GASTROINTESTINAL COMPLICATIONS FOLLOWING ORTHOTOPIC LUNG TRANSPLANTATION Gary R. Lichtenstein, Erica I. Lubetkin, Harold L Palevsky, Robert Kotloff, M.D., Jon Morris, M.D., Jesse A. Berlin, Joseph E. Bavaria Angela B. Wurster, Larry R. Kaiser, M.D. Departments of Medicine, Surgery, and Center for Clinical Epidemiology and Binstatistics, Hospital of the University of Pennsylvania (HUP), Philadelphia, PA. Background/Aims: Within the last decade lung transplantation has been performed with increasing frequency and successful outcomes. Systematic analsysis of GI complications in a large cohort of lung traiasplant recipients has not been performed to date. The present Study describes and categorizes such GI complications. Methods: Between November 1991 and January 1994, 45 patients underwent 47 single or bilateral o'rthotopic lung transplant procedures at the HUP. Immunosuppression consisted of cyclosporine, azathioprine, and corticosteroids. A retrospective chart analysis was performed, ..Results: Twenty-three patients (51%) had 69 gastrointestinal complications. Thirteen operative procedures were required in 8 patients. Operations included colon resection with colostomy (n=4), exploratory laparotomy with loop jejunostomy (n=l), antrectomy with Bilroth II anastomosis and cholecystostomy (n=l), drainage of a falciform ligament abscess (n=l), drainage and debridement of a perisplenic abscess with cholecystectomy (n=l), cholecystostomy (n=l), exploratory laparotomy (n=2), diagnostic laparoscopy (n=l), and femoral hernia repair (n=l). The operative mortality rate was 63% (5/8). Nineteen nonoperative complications were recognized and further subclassifie d into major and minor; the former of which included hyperammonemia (n=3), Ogilvie's syndrome (n=l), diverticulitis (n=2), reflux esophagitis (n=6), peptic ulcer disease (n=3), gastritis (n=4), gastrointestinal bleeding (n=2), CMV hepatitis (n=3), CMV colitis (n=l), choledocholithiasis (n=l), and C. difficile toxin positive diarrhea (n=7). Overall survival in patients with GI complications was 52% (12/23) compared to 77% (17/22) in patients without complications (p=0.176, NS). The vast majority of GI complications (74%) occurred within one month after transplantaiou. No significant correlation was found between GI complications and age, gender~ number of rejection episodes, outcome, time of transplantation (early versus recent), and primary disease. The only trends achieving statistical significanc e included time of transplantation and survival and age and survival, both of which failed to attain significance when tested with developing GI complications (p=0.20g, NS). Conclusions: GI complications are common postoperatively in lung transplantation patients, occurring in more than half of all patients. Since no precedent risk factors suggest which patients are likely to develop GI complications, clinicians must be alert to any warning signs and symptoms, especially during the first month after transplantation. Although the majority of complications were nonoperative and responsive to conservative therapy, there was a higher overall mortality rate for those patients requiring operative intervention, mandating an aggressive search for major, life-threatening complications in these immunosuppressed patients. A eQuality of Life Derived Benefit Score n and the evaluation of a procedure: the Pereutaneous Endoscopic Gastrostomy S.D. Lippe. J.G. O'Brien, C. Cook, LA. Balint. Division of Gastrnenterology and Center for Medical Ethics, Albany Medical Center, New York.