Chest
Volume 108, Issue 6, December 1995, Pages 1602-1607
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Clinical Investigations: Lung Transplantation
Gastroparesis After Lung Transplantation: Potential Role in Postoperative Respiratory Complications

https://doi.org/10.1378/chest.108.6.1602Get rights and content

Background

We observed an unexpectedly High incidence of postoperative gastroparesis among lung and heart-lung transplant recipients.

Purpose

To identify the incidence of GI complications and to describe the clinical profiles of patients who developed symptomatic gastroparesis after lung transplantation.

Patients and methods

Retrospective study of GI symptoms and complications identified during 3 years of follow-up of 38 adult lung and heart-lung transplant recipients.

Results

Sixteen of 38 patients (42%) reported one or more GI complaint and received a specific GI diagnosis. Nine of 38 patients (24%) complained of early satiety, epigastric fullness, anorexia, nausea, or vomiting. Gastroparesis was suspected when endoscopic evaluation revealed undigested food in the stomach after overnight fast and symptoms could not be attributed to peptic disease or cytomegalovirus gastritis. Delayed gastric emptying was confirmed by gastric scintigraphy. Mean gastric emptying (t½) was 263±115 min (normal <95 min). Gastroparesis occurred in 4 of 13 right lung, 2 of 12 left lung, 1 of 9 bilateral single lung, and 2 of 4 heart-lung recipients (p=NS). Patients responded partially to metoclopramide or cisapride, with the exception of two patients who required placement of jejunal feeding tubes secondary to severe symptoms. In long-term follow-up, symptoms resolved in all patients and treatment with medications or mechanical intervention was successfully discontinued. Four of nine patients (44%) suffering from gastroparesis developed obliterative bronchiolitis (OB). Food particles were discovered in the BAL fluid of two such symptomatic patients. In contrast, only 6 of 29 (21%) nonsymptomatic patients developed OB (p=0.16). Conclusion: Symptomatic gastroparesis is a frequent complication of lung or heart-lung transplantation that may promote microaspiration into the lung allograft.

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

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