Browse > Article

Gastrointestinal Complication in Transplant Patients  

Kim, Gun-Min (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
Cheung, Dae-Young (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
Kim, Jin-Il (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
Publication Information
Clinical Endoscopy / v.41, no.2, 2010 , pp. 65-71 More about this Journal
Abstract
The gastrointestinal tract is one of the major sites for complications after solid organ and hematopoietic stem cell transplantation, and gastrointestinal complications are the principle cause of morbidity and death. The major gastrointestinal complications after transplantation include mucositis, typhlitis, infectious enterocolitis by virus, bacteria or fungus, pseudomembranous colitis, gastric ulcer, graftversus-host disease, pneumatosis cystoides intestinalis, thrombotic microangiopathy and post-transplantation lymphoproliferative disease. Symptoms and signs of gastrointestinal complications following transplantation are often non-specific and present with varying severity. Moreover, the suppressed immune state often prohibits invasive studies including endoscopy and blurs the serologic and hematologic results. Therefore, it is hard to reach accurate diagnoses even after thorough investigations. Almost all immunosuppressive drugs can lead to gastrointestinal complications and we need proper strategies to minimize their side effects. On the one hand, we can expect better organ and patient survival through the judicious use of a broad range of immunosuppressive drugs; on the other hand, we should try to not ruin survival through proper precautions and early treatment of gastrointestinal complications following successful transplantation.
Keywords
Transplantation; Gastrointestinal diseases; Immunosuppression; Graft-Versus-Host Disease;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Welch DC, Wirth PS, Goldenring JR, Ness E, Jagasia M, Washington K. Gastric graft-versus-host disease revisited: does proton pump inhibitor therapy affect endoscopic gastric biopsy interpretation? Am J Surg Pathol 2006;30:444-449.   DOI   ScienceOn
2 Roy J, Snover D, Weisdorf S, Mulvahill A, Filipovich A, Weisdorf D. Simultaneous upper and lower endoscopic biopsy in the diagnosis of intestinal graft-versus-host disease. Transplantation 1991;51:642-646.   DOI   ScienceOn
3 Nishida T, Hamaguchi M, Hirabayashi N, et al. Intestinal thrombotic microangiopathy after allogeneic bone marrow trasplanatation: a clinical imitator of acute enteric graft-versushost disease. Bone Marrow Transplant 2004;33:1143-1150.   DOI   ScienceOn
4 Tsai DE, Hardy CL, Tomaszewski JE, et al. Reduction in immunosuppression as initial therapy for posttransplant lymphoproliferative disorder: analysis of prognostic variables and long-term follow-up of 42 adult patients. Transplantation 2001;71:1076-1088.   DOI   ScienceOn
5 Myers JD, Flournoy N, Thomas ED. Risk factors for cytomegalovirus infection after human marrow transplantation. J Infect Dis 1986;153:478-488.   DOI   ScienceOn
6 Troppmann C, Papalois BE, Chiou A, et al. Incidence, complications, treatment, and outcome of ulcers of the upper GI tract after renal transplantation during the cyclosporine era. J Am Coll Surg 1995;180:433-443.
7 Steger AC, Timmoney AS, Griffen S, Salem RR, Williams G. The influence of immunosuppression on peptic ulceration following renal transplantation and the role of endoscopy. Nephrol Dial Transplant 1990;5:289-292.   DOI   ScienceOn
8 Skala I, Mareckova O, Vitko S, Matl I, Lacha J. Prophylaxis of acute gastroduodenal bleeding after renal transplantation. Transpl Int 1997;10:375-378.   DOI
9 Yang CW, Lee SH, Kim YS, et al. Prevention of posttransplant peptic ulcer by misoprostol. Nephron 1996;74:131-135.   DOI   ScienceOn
10 Ferrara JL, Deeg HJ. Graft-versus-host disease. N Engl J Med 1991;324:667-674.   DOI   ScienceOn
11 Merine DS, Fishman EK, Jones B, Nussbaum AR, Simmons T. Right lower quadrant pain in the immunocompromised patient: CT findings in 10 cases. AJR Am J Roentgenol 1987; 149:1177-1179.   DOI   ScienceOn
12 Winston DJ, Pakrasi A, Busuttil RW. Prophylactic fluconazole in liver transplant recipients. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1999;131:729-737.
13 Patel R. Prophylactic fluconazole in liver transplant recipients: a randomized, double-blind, placebo-controlled trial. Liver Transpl 2000;6:376-379.   DOI   ScienceOn
14 Urbach DR, Rotstein OD. Typhlitis. Can J Surg 1999;42: 415-419.
15 West M, Pirenne J, Chavers B, et al. Clostridium difficile colitis after kidney and kidney-pancreas transplantation. Clin Transplant 1999;13:318-323.   DOI   ScienceOn
16 Helderman JH, Goral S. Gastrointestinal complications of transplant immunosuppression. J Am Soc Nephrol 2002;13: 277-287.
17 Badley AD, Seaberg EC, Porayko MK, et al. Prophylaxis of cytomegalovirus infection in liver transplantation: a randomized trial comparing a combination of ganciclovir and acyclovir to acyclovir. NIDDK Liver Transplantation Database. Transplantation 1997;64:66-73.   DOI   ScienceOn
18 Lowance D, Neumayer HH, Legendre CM, et al. Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. International Valacyclovir Cytomegalovirus Prophylaxis Transplantation Study Group. N Engl J Med 1999; 340:1462-1470.   DOI   ScienceOn
19 Mosimann F, Cuenoud PF, Steinhauslin F, Wauters JP. Herpes simplex esophagitis after renal transplantation. Transpl Int 1994;7:79-82.   DOI   ScienceOn
20 Mori T, Mori S, Kanda Y, et al. Clinical significance of cytomegalovirus (CMV) antigenemia in the prediction and diagnosis of CMV gastrointestinal disease after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2004;33:431-434.   DOI   ScienceOn
21 Patel R, Snydman DR, Rubin RH, et al. Cytomegalovirus prophylaxis in solid organ transplant recipients. Transplantation 1996;61:1279-1289.   DOI   ScienceOn
22 Gavalda J, de Otero J, Murio E, et al. Two grams daily of oral acyclovir reduces the incidence of cytomegalovirus disease in CMV-seropositive liver transplant recipients. Transpl Int 1997;10:462-465.   DOI
23 Loren AW, Tsai DE. Post-transplant lymphoproliferative disorder. Clin Chest Med 2005;26:631-645.   DOI   ScienceOn
24 Armitage JO. Bone marrow transplantation. N Engl J Med 1994;330:827-838.   DOI   ScienceOn
25 Barker CC, Anderson RA, Sauve RS, Butzner JD. GI complications in pediatric patients post-BMT. Bone Marrow Transplant 2005;36:51-58.   DOI   ScienceOn
26 Sakr M, Hassanein T, Gavaler J, et al. Cytomegalovirus infection of the upper GI tract following liver transplantation-- incidence, location, and severity in cyclosporine- and FK506- treated patients. Transplantation 1992;53:786-791.   DOI   ScienceOn
27 Lones MA, Kirov I, Said JW, Shintaku IP, Neudorf S. Posttransplant lymphoproliferative disorder after autologous peripheral stem cell transplantation in a pediatric patient. Bone Marrow Transplant 2000;26:1021-1024.   DOI   ScienceOn
28 Allen U, Hebert D, Moore D, Dror Y, Wasfy S; Canadian PTLD Survey Group--1998. Epstein-Barr virus-related posttransplant lymphoproliferative disease in solid organ transplant recipients, 1988-97: a Canadian multi-centre experience. Pediatr Transplant 2001;5:198-203.   DOI   ScienceOn
29 Lim GY, Newman B, Kurland G, Webber SA. Post transplantation lymphoproliferative disorder: manifestations in pediatric thoracic organ recipients. Radiology 2002;222:699-708.   DOI   ScienceOn
30 Harris NL, Ferry JA, Swerdlow SH. Posttransplant lymphoproliferative disorders: summary of Society for Hematopathology Workshop. Semin Diagn Pathol 1997;14:8-14.
31 Cohen JI. Epstein-Barr virus infection. N Engl J Med 2000;343:481-492.   DOI   ScienceOn
32 Cheung DY, Kim JI, Kim SS, et al. Endoscopic evaluation in gastrointestinal graft-versus-host disease: comparisons with histological findings. Dig Dis Sci 2008;53:2947-2954.   DOI   ScienceOn
33 Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol 2005;56:155-167.   DOI   ScienceOn
34 Cockfield SM. Identifying the patient at risk for posttransplant lymphoproliferative disorder. Transpl Infect Dis 2001;3:70-78.   DOI   ScienceOn
35 Nalesnik MA. Posttransplantation lymphoproliferative disorders (PTLD): current perspectives. Semin Thorac Cardiovasc Surg 1996;8:139-148.
36 Cox GJ, Matsui SM, Lo RS, et al. Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology 1994;107:1398-1407.   DOI
37 Appleton AL, Sviland L, Pearson AD, Green MA, Eastham EJ, Malcolm AJ. The need for endoscopic biopsy in the diagnosis of upper gastrointestinal graft-versus-host disease. J Pediatr Gastroenterol Nutr 1993;16:183-185.   DOI
38 Thompson B, Salzman D, Steinhauer J, Lazenby AJ, Wilcox CM. Prospective endoscopic evaluation for gastrointestinal graft-versus-host disease: determination of the best diagnostic approach. Bone Marrow Transplant 2006;38:371-376.   DOI   ScienceOn
39 Cruz-Correa M, Poonawala A, Abraham SC, et al. Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease. Endoscopy 2002;34:808-813.   DOI   ScienceOn
40 Narimatsu H, Kami M, Hara S, et al. Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation. Bone Marrow Transplant 2005;36: 517-523.   DOI   ScienceOn
41 Oomori S, Takagi S, Kikuchi T, et al. Significance of colonoscopy in patients with intestinal graft-versus-host disease after hematopoietic stem cell transplantation. Endoscopy 2005;37:346-350.   DOI   ScienceOn
42 Iqbal N, Salzman D, Lazenby AJ, Wilcox CM. Diagnosis of gastrointestinal graft-versus-host disease. Am J Gastroenterol 2000;95:3034-3038.   DOI   ScienceOn
43 Schulenburg A, Kalhs P, Rabitsch W. Recommendations for diagnosis of acute gastrointestinal graft-versus-host disease in the small intestine. Transplantation 2005;79:1767.
44 Xu CF, Zhu LX, Xu XM, Chen WC, Wu DP. Endoscopic diagnosis of gastrointestinal graft-versus-host disease. World J Gastroenterol 2008;14:2262-2267.   DOI   ScienceOn
45 Lee JK, Cho JY, Kim YS, et al. Comparative value of sigmoidoscopy and stool cytotoxin-A assay for diagnosis of pseudomembranous colitis. Intest Res 2005;3:61-67.