Rakhit Amit, Nurko Samuel, Gauvreau Kimberlee, Mayer John E, Blume Elizabeth D
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
J Heart Lung Transplant. 2002 Jul;21(7):751-9. doi: 10.1016/s1053-2498(02)00383-2.
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.
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.
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.
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.
小儿心脏移植术后主要胃肠道并发症的发生率尚未得到充分描述。针对成人的研究表明，移植后胃肠道并发症会导致显著的发病率和死亡率。在本研究中，我们调查了小儿心脏移植人群中的主要胃肠道并发症。
我们对在波士顿儿童医院接受心脏移植的所有患者进行了回顾性分析，包括所有相关的临床、放射学、内镜检查和病理学检查结果。1986年5月至2000年12月期间，104例患者接受了105次原位心脏移植。如果胃肠道并发症显著延长住院时间、需要住院治疗或需要手术干预，则被定义为主要并发症。
移植时的中位年龄为8.7岁（范围为2周至23岁）。中位随访时间为3.3年（范围为2天至14.9年）。所有患者最初均接受环孢素、泼尼松和硫唑嘌呤的标准三联免疫抑制治疗。在此期间，19例患者（18%）发生了30次主要并发症事件，包括胰腺炎（7例）、胆囊炎（6例）、复发性腹部感染（5例）、恶性肿瘤（4例）、肠壁囊样积气（4例）、结肠穿孔（2例）、阑尾炎（1例）、克罗恩病（1例）和部分小肠梗阻（1例）。19例发生主要胃肠道并发症的患者中有10例（53%）需要手术干预。
小儿心脏移植术后可发生严重的胃肠道并发症，其发生率与成人相似。由于可能需要手术的并发症发生率较高，因此应对小儿心脏移植患者的胃肠道症状进行积极评估。
