Original scientific article
Colon and Rectal Complications after Heart and Lung Transplantation

https://doi.org/10.1016/j.jamcollsurg.2005.08.025Get rights and content

Background

Gastrointestinal complications of solid organ transplantation have been well described, but little attention has been paid to colorectal disorders in particular. The purpose of this study was to identify the incidence and severity of colorectal complications among a large cohort of heart and lung transplant recipients.

Study design

We reviewed the medical records of heart, lung, and heart-lung transplant recipients at a single institution between 1978 and 2004. Complications were identified based on need for consultation, endoscopy, or operation by a colorectal surgeon after transplantation.

Results

Of 1,012 patients who received transplantations (530 heart, 435 lung, 47 heart-lung), 56 patients (6%) required evaluation for 84 colorectal problems. Incidence of complications was 7% in lung transplant recipients, 6% in heart-lung transplant recipients, and 4% in heart transplant recipients. Forty-four events (52%) were considered major (diverticulitis, perforation, malignancy, and other) and 40 (48%) were minor (polyps, pseudo-obstruction treated medically or endoscopically, benign anorectal disease, and other). Twenty-three (27%) required colectomy and 9 (10%) necessitated anal operation. Thirty-six (43%) required less-invasive interventions (endoscopy, minor anorectal procedures, and other). Eighteen (21%) were treated with medical therapy alone. Six patients died from colorectal disease (7%).

Conclusions

Colorectal complications are a considerable source of morbidity and mortality after heart and lung transplantation. These complications occur more frequently in patients who undergo lung and heart-lung transplantation as compared with heart transplantation alone.

Section snippets

Patient selection

We retrospectively reviewed the medical records of all heart, lung, and heart-lung transplant recipients who required evaluation by a member of the Division of Colon and Rectal Surgery at the University of Minnesota between January 1, 1978, and November 15, 2004. Patients were included in the study if they required an opinion or intervention (endoscopic or surgical) by a CR surgeon on or after the date of transplantation. Events were classified as primarily CR or AR. Major complications were

Results

Between January 1, 1978 and November 15, 2004, 1,012 patients received thoracic transplantations (530 heart, 435 lung, and 47 heart-lung recipients). The ratio of men to women was approximately 2:1. Mean age at transplantation was 52.6 years (range 20 to 71 years). The most common disorder necessitating lung transplantation was obstructive lung disease. Heart transplantation was performed most often for ischemic cardiomyopathy. Heart-lung transplantations were performed for primary pulmonary

Discussion

Although CR and AR problems are common complications of abdominal solid organ transplantation, little is known about their incidence and severity in thoracic transplantation. Small studies focusing on complications of the lower GI tract have been performed in renal transplant recipients, and the incidence of colonic complications in these reports ranges from 7.4% to 8.6%.6, 7 A larger series following more than 2,000 renal transplant patients over 30 years found a 0.5% incidence of colonic

References (33)

  • C. Soravia et al.

    Acute colonic complications after kidney transplantation

    Acta Chir Belg

    (1995)
  • J.R. Maurer

    The spectrum of colonic complications in a lung transplant population

    Ann Transplant

    (2000)
  • S. Khan et al.

    Acute diverticulitis in heart- and lung transplant patients

    Transplant Int

    (2001)
  • O. Detry et al.

    Acute diverticulitis in heart transplant recipients

    Transplant Int

    (1996)
  • J.J. Fenton et al.

    Sigmoid diverticular perforation complicating lung transplantation

    J Heart Lung Transplant

    (1997)
  • J.Y. Kang et al.

    Diverticular disease of the colon—on the risea study of hospital admissions in England between 1989/1990 and 1999/2000

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    Competing Interests Declared: None.

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