Bardaxoglou E, Maddern G, Ruso L, Siriser F, Campion J P, Le Pogamp P, Catheline J M, Launois B
Transplantation Unit, Bloc Hôpital Pontchaillou, Rennes, France.
Transpl Int. 1993 May;6(3):148-52. doi: 10.1007/BF00336358.
This study reports major gastrointestinal complications in a group of 416 patients following kidney transplantation. Three hundred and ninety-nine patients received a cadaveric kidney while the other 17 received a living related organ. The immunosuppressive regimen changed somewhat during the course of the study but included azathioprine, prednisolone, antilymphocyte globulin, and cyclosporin. Perforations occurred in the colon (n = 6), small bowel (n = 4), duodenum (n = 2), stomach (n = 1), and esophagus (n = 1). There were five cases of acute pancreatitis, four of upper gastrointestinal and two of lower intestinal hemorrhage, two of acute appendicitis, one of acute cholecystitis, one postoperative mesenteric infarction, and two small bowel obstructions. Fifty percent of the complications occurred while patients were being given high-dose immunosuppression to manage either the early postoperative period or episodes of acute rejection. Ten percent of the complications had an iatrogenic cause. Of the 31 patients affected, 10 (30%) died as a direct result of their gastrointestinal complication. This high mortality appears to be related to the effects of the immunosuppression and the associated response to sepsis. Reduction of these complications can be achieved by improved surgical management, preventive measures, prompt diagnosis, and a reduced immunosuppressive protocol.
本研究报告了416例肾移植患者发生的主要胃肠道并发症。399例患者接受了尸体肾移植，另外17例接受了亲属活体器官移植。在研究过程中，免疫抑制方案略有变化，但包括硫唑嘌呤、泼尼松龙、抗淋巴细胞球蛋白和环孢素。穿孔发生在结肠（n = 6）、小肠（n = 4）、十二指肠（n = 2）、胃（n = 1）和食管（n = 1）。有5例急性胰腺炎、4例上消化道出血和2例下消化道出血、2例急性阑尾炎、1例急性胆囊炎、1例术后肠系膜梗死和2例小肠梗阻。50%的并发症发生在患者接受高剂量免疫抑制治疗以处理术后早期或急性排斥反应发作时。10%的并发症有医源性原因。在31例受影响的患者中，10例（30%）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。通过改进手术管理、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。
