Chest
Clinical Investigations: Lung TransplantationGastroparesis After Lung Transplantation: Potential Role in Postoperative Respiratory Complications
Section snippets
Methods
The study population consisted of 38 consecutive adult patients who survived lung or heart-lung transplantation at the Presbyterian Hospital in New York City between 1989 and 1992. Of these 38 patients, 25 received single lung transplants (13 right lung, 12 left lung) for emphysema (n=18), pulmonary fibrosis (n=4), or pulmonary hypertension (n=3). Nine patients received bilateral single lung transplants for cystic fibrosis (n=7) or bronchiectasis (n=2). Four patients received combined
Results
Persistent GI symptoms were described on follow-up clinic visits for 16 of 38 (42%) patients (Table 1). Specific symptoms were abdominal pain (n=10), dyspepsia (n=8), nausea and vomiting (n=7), early satiety (n=6), and severe diarrhea (n=l). There were 29 specific GI diagnoses in 16 (42%) of 38 patients (Table 1). The most common diagnoses were gastritis (n=9) and gastroparesis (n=9). Three patients had symptomatic cholelithiasis and required cholecystectomy. Rarer complications included
CASE REPORTS
A 23-year-old-woman with idiopathic pulmonary hypertension underwent right lung transplant. The early postoperative course was complicated by severe ischemia-reperfusion injury, respiratory insufficiency, and bilateral pneumonitis. She recovered sufficiently to leave the hospital 2 months after transplant. One month later, she developed upper abdominal pain, nausea, and vomiting. Upper endoscopy revealed retained food particles, but no ulcers or CMV gastritis. Gastric scintigraphy showed
Discussion
Lung and heart-lung transplantation have become accepted treatment modalities for end-stage pulmonary disease at many institutions worldwide. In recent years, operative mortality has declined and 1- and 3-year survival rates have improved.4 Respiratory infection and chronic allograft rejection, however, remain important causes of postoperative mortality. One study of heart-lung transplant recipients identified GI complications as a potential precipitant of respiratory infection and as a factor
References (14)
- et al.
Importance of chronic aspiration in recipients of heart-lung transplants
Lancet
(1990) - et al.
Relationship between impaired gastric emptying and abnormal gastrointestinal motility
Gastroenterology
(1986) Gastric dysrhythmias; pathophysiologic and etiologic factors
Mayo Clin Proc
(1989)- et al.
Postoperative gastric atony after vagotomy for obstructing peptic ulcer
Am J Surg
(1989) - et al.
Sudden onset of slow gastric emptying of food
Gastroenterology
(1979) - et al.
Post-transplant obliterative bronchiolitis and other late sequelae in human heart-lung transplantation
Chest
(1984) - et al.
The pathology of combined heart-lung transplantation: an autopsy study
Hum Pathol
(1988)