Management of general surgical complications following cardiac transplantation
V. J. DiSesa, R. L. Kirkman, N. L. Tilney, G. H. Mudge, J. J. Collins Jr and L. H. Cohn
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115.
Between February 1984 and May 1988, 55 patients underwent orthotopic
cardiac transplantation at the Brigham and Women's Hospital, Boston, Mass.
Basic immunosuppression was accomplished with steroid and cyclosporine
therapies. Twelve patients suffered 14 major complications, including
perforated ulcer in 3 patients; pancreatitis in 3 patients; pneumatosis
coli in 2 patients; and cholecystitis, colonic necrosis, appendicitis,
incarcerated umbilical hernia, pancreatic abscess, and toxic epidermal
necrolysis in 1 patient each. Aggressive management of the patients
included laparotomy in all but 2 patients with mild pancreatitis and the
patient with toxic epidermal necrolysis, who was treated as a patient with
a severe burn. In all of the patients, there was a resolution of these
complications, except in one 59-year-old man with fatal hemorrhagic
pancreatitis. Eleven of the 14 complications occurred during the initial
hospitalization. The fatal case of pancreatitis was 1 of 5 (9%) operative
mortalities in the entire series. Fifty operative survivors have been
followed up for an average of 19 months, with four late deaths (8%) related
to rejection. The actuarial probability of survival in patients discharged
from the hospital was 90% at 12, 24, and 48 months.
