Department of Cardiovascular and Thoracic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan; Department of Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan.
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Transplant Proc. 2021 May;53(4):1379-1381. doi: 10.1016/j.transproceed.2021.02.006. Epub 2021 Mar 10.
Pneumatosis intestinalis (PI) is a rare but critical condition in which gas is found in the bowel wall. Although organ transplant recipients have an increased PI risk because of long-term immunosuppression, alpha-glucosidase inhibitors (α-GI), a standard diabetes therapy, often contribute to PI. However, little is known about the postorgan transplantation relationship between PI and α-GI. To the best of our knowledge, this is the first reported case of PI in a lung transplant recipient treated with α-GI.
A 59-year-old man underwent hybrid (living-donor and cadaveric) lung transplantation (LTx). The patient was treated with prednisolone and tacrolimus as immunosuppressive therapy and α-GI for diabetes for 4 years. He developed asymptomatic PI 1031 days after transplantation without any acute abdominal finding. After excluding other possible causes of PI, his PI was attributed to α-GI. The suspected α-GI was immediately withdrawn. The patient was managed conservatively with bowel rest and oxygen therapy. After 11 days of α-GI discontinuation, PI improved, and the patient completely recovered.
Physicians should keep this rare adverse drug reaction in mind when prescribing α-GI, particularly in patients with diabetes after organ transplantation and including LTx. The management strategy for asymptomatic PI caused by α-GI is the immediate discontinuation of α-GI therapy, followed by conservative management initiation.
肠气肿（PI）是一种罕见但危急的病症，其特征是肠壁内有气体。尽管器官移植受者由于长期免疫抑制而增加了 PI 的风险，但α-葡萄糖苷酶抑制剂（α-GI），一种标准的糖尿病治疗药物，通常也会导致 PI。然而，PI 与 α-GI 之间在器官移植后的关系知之甚少。据我们所知，这是首例报道的接受 α-GI 治疗的肺移植受者发生 PI 的病例。
一名 59 岁男性接受了杂交（活体供体和尸体）肺移植（LTx）。患者接受泼尼松龙和他克莫司作为免疫抑制治疗，并在移植后 4 年内接受 α-GI 治疗糖尿病。他在移植后 1031 天无症状发生 PI，没有任何急性腹部发现。排除了 PI 的其他可能病因后，他的 PI 归因于 α-GI。立即停用可疑的 α-GI。患者通过肠道休息和氧疗进行保守治疗。停用 α-GI 11 天后，PI 得到改善，患者完全康复。
当开具 α-GI 处方时，医生应牢记这种罕见的药物不良反应，特别是在糖尿病患者进行器官移植后，包括 LTx。由 α-GI 引起的无症状 PI 的管理策略是立即停用 α-GI 治疗，然后开始保守治疗。
