Related Experiment Videos
Complications in cardiac transplant patients requiring general surgery
R Colon1, O H Frazier, B D Kahan
1Division of Surgery, Texas Heart Institute, Houston 77225.
Insights
Heart transplant recipients on cyclosporine A and prednisone experienced significant gastrointestinal complications, particularly pancreatitis and cholecystitis. Early identification and aggressive management are crucial for better outcomes in these complex surgical cases.
Area of Science:
- Cardiology
- Gastroenterology
- Transplantation Surgery
Background:
- Heart transplantation is a viable treatment for end-stage cardiac disease.
- Cyclosporine A and prednisone are standard immunosuppressants post-transplantation.
- Gastrointestinal complications can arise in heart transplant recipients.
Purpose of the Study:
- To analyze the incidence and nature of general surgical complications in heart transplant patients.
- To evaluate the outcomes of surgical interventions for these complications.
Main Methods:
- Retrospective review of 86 heart transplantations performed between July 1982 and December 1985.
- Analysis of patients requiring general surgical consultation due to complications.
- Detailed examination of affected organ systems and interventions.
Main Results:
- Thirty patients (34.9%) experienced complications requiring surgical consultation.
- Pancreas (16 cases) and biliary tract (9 cases) were most commonly affected.
- Pancreatitis had a 40% mortality rate in those requiring surgery; cholecystitis cases survived cholecystectomy.
Conclusions:
- Heart transplant patients are prone to severe gastrointestinal complications.
- Aggressive management, including immunosuppression adjustment and timely surgery, improves outcomes.
- Multidisciplinary care is essential for managing surgical complications in transplant recipients.
Abstract:
With the advent of cyclosporine A, heart transplantation has become a widely accepted treatment for patients with end-stage cardiac disease that is not amenable to medical or surgical treatment. Between July 1982 and December 1985, 86 heart transplantations were performed at the Texas Heart Institute with cyclosporine A and prednisone used for immunosuppression. Thirty patients had complications requiring general surgical consultation. The pancreas and biliary tracts were most commonly affected. Pancreatitis developed in sixteen patients; five patients required operative intervention, resulting in a 40% mortality rate. Five of nine patients with cholecystitis required cholecystectomy. All patients survived the procedures. Other gastrointestinal complications included colonic ileus, bowel perforation, gastrointestinal bleeding, gastric outlet obstruction, and perirectal abscess. Patients who have undergone cardiac transplantation are susceptible to life-threatening infections and are at risk of serious complications requiring general surgical intervention. Better results can be obtained in these complex clinical situations when complications are identified early and managed aggressively through the adjustment of immunosuppression, adequate selection of antimicrobial agents, and proper timing of surgical intervention.