Esophageal Perforation in a Patient With Kidney Transplantation

Area of Science:

• Gastroenterology
• Transplant Surgery
• Immunology

Background:

• Esophageal perforation is a rare but serious complication, often iatrogenic, with increasing incidence linked to endoscopic procedures.
• Organ transplantation necessitates immunosuppression, which can increase risks for gastrointestinal complications.
• The management of esophageal perforation post-transplant presents unique challenges due to the patient's immunocompromised state.

Observation:

• A 54-year-old female kidney transplant recipient developed esophageal perforation 8 days post-transplantation.
• The patient had a prior gastrointestinal consultation before her transplant.
• Immunosuppressive therapy included mycophenolate mofetil, cyclosporine, and high-dose corticosteroids.

Findings:

• Esophageal perforation can occur in the early post-transplant period (within 2 weeks) following organ transplantation.
• High-dose immunosuppressants, particularly corticosteroids, may contribute to esophageal ulceration and perforation, especially with delayed passage or dysphagia.
• This case underscores the potential for esophageal perforation after any organ transplant, not limited to specific types.

Implications:

• Clinicians should maintain a high index of suspicion for esophageal perforation in transplant recipients presenting with gastrointestinal symptoms.
• Preventive measures, such as judicious use of intravenous steroids and divided pill dosages, may mitigate risks.
• Prompt diagnosis and management are essential to improve outcomes in this vulnerable patient population.