Catena F, Ansaloni L, Gazzotti F, Bertelli R, Severi S, Coccolini F, Fuga G, Nardo B, D'Alessandro L, Faenza A, Pinna A D
St. Orsola-Malpighi University Hospital, Bologna, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1895-6. doi: 10.1016/j.transproceed.2008.06.007.
This study reports major gastrointestinal (GI) complications among a group of 1611 patients following kidney transplantation. The immunosuppressive regimen changed somewhat during the course of the study but included azathioprine, prednisolone, antilymphocyte globulin, cyclosporine, tacrolimus, mycophenolate mofetil, and sirolimus. Perforations occurred in the colon (n=21), small bowel (n=15), duodenum (n=6), and stomach (n=4). Nearly 50% of the complications occurred while patients were being given high-dose immunosuppression to manage either the early postoperative period or acute rejection episodes. Of the 46 patients affected, 11 (24%) died as a direct result of the GI complication. This high mortality appeared to be related to the effects of the immunosuppression and the associated response to sepsis. Reduction of these complications may be achieved by improved surgical management, preventive measures, prompt diagnosis, and a reduced immunosuppressive protocol.
本研究报告了1611例肾移植患者群体中的主要胃肠道并发症。在研究过程中，免疫抑制方案有所变化，但包括硫唑嘌呤、泼尼松龙、抗淋巴细胞球蛋白、环孢素、他克莫司、霉酚酸酯和西罗莫司。穿孔发生在结肠（n = 21）、小肠（n = 15）、十二指肠（n = 6）和胃（n = 4）。近50%的并发症发生在患者接受大剂量免疫抑制治疗以处理术后早期或急性排斥反应期间。在46例受影响的患者中，11例（24%）直接死于胃肠道并发症。这种高死亡率似乎与免疫抑制的影响以及对败血症的相关反应有关。通过改善手术管理、预防措施、及时诊断和减少免疫抑制方案，可以降低这些并发症的发生率。
