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Gastrointestinal complications after pediatric cardiac transplantation
Amit Rakhit1, Samuel Nurko, Kimberlee Gauvreau
1Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Major gastrointestinal complications occur in 18% of pediatric heart transplant recipients, similar to adults. Aggressive evaluation of GI symptoms is crucial due to potential surgical needs in these patients.
Area of Science:
- Pediatric Cardiology
- Gastroenterology
- Transplantation Medicine
Background:
- Gastrointestinal complications post-pediatric heart transplant are not well-defined.
- Adult transplant studies indicate significant morbidity and mortality from these complications.
- This study characterizes major gastrointestinal complications in pediatric heart transplant recipients.
Purpose of the Study:
- To investigate the incidence and types of major gastrointestinal complications following pediatric heart transplantation.
- To compare complication rates in pediatric patients to those reported in adult populations.
Main Methods:
- Retrospective analysis of pediatric heart transplant patients (n=104) from May 1986 to December 2000.
- Inclusion of clinical, radiologic, endoscopic, and pathologic data.
- Definition of major gastrointestinal complications as those prolonging hospitalization, requiring admission, or necessitating surgical intervention.
Main Results:
- 18% of patients (19/104) experienced 30 major gastrointestinal complication episodes.
- Common complications included pancreatitis, cholecystitis, and abdominal infections.
- 53% of affected patients required surgical intervention for their gastrointestinal issues.
Conclusions:
- Pediatric heart transplant recipients face serious gastrointestinal complications, with an incidence comparable to adults.
- Prompt and thorough evaluation of gastrointestinal symptoms is essential in this patient group.
- Early detection and management can mitigate the need for surgical intervention.
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.