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Clinical Investigations: CYSTIC FIBROSIS |

GI Complications After Lung Transplantation in Patients With Cystic Fibrosis*

Marita Gilljam, MD; Cecilia Chaparro, MD; Elizabeth Tullis, MD FCCP; Charles Chan, MD, FCCP; Shaf Keshavjee, MD, FCCP; Michael Hutcheon, MD, FCCP
Author and Funding Information

*From the Department of Respiratory Medicine and Allergology (Dr. Gilljam), Sahlgrenska University Hospital, Goteborg University, Goteborg, Sweden; and the Toronto Lung Transplant Program (Dr. Chaparro), Toronto General Hospital; the Adult CF Program (Dr. Tullis), St Michael’s Hospital; and Departments of Medicine (Drs. Chan and Hutcheon) and Surgery (Dr. Keshavjee), University of Toronto, Toronto, ON, Canada.

Correspondence to: Michael Hutcheon, MD, FCCP, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada



Chest. 2003;123(1):37-41. doi:10.1378/chest.123.1.37
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Study objective: Lung transplantation is now available for patients with cystic fibrosis (CF) and end-stage lung disease. While pulmonary graft function is often considered the major priority following transplantation, the nonpulmonary complications of this systemic disease also continue. We examined the GI complications in a cohort of patients who underwent transplantation.

Design: This was a retrospective study of all patients with CF who underwent transplantation between March 1988 and December 1998 in Toronto. Medical records were reviewed, and a short questionnaire was mailed to patients who were alive as of December 1998.

Results: There were 80 bilateral lung transplants performed in 75 patients. The questionnaire was distributed to 43 patients, of whom 27 patients (63%) responded. Pancreatic insufficiency requiring enzyme intake was evident in 72 of 75 patients (96%) at the time of surgery. Of three pancreatic-sufficient patients (4%), pancreatic insufficiency was diagnosed in two patients later. Biliary cirrhosis was diagnosed in three patients prior to transplantation. Distal intestinal obstruction syndrome (DIOS) was recorded for 15 patients (20%). Ten patients had a single episode, of which eight episodes occurred early in the postoperative period. Five patients had recurrent episodes. All were medically treated, except for two patients who underwent surgery. Other complications included cholecystitis (n = 3), mucocele of the appendix (n = 1), peptic ulcer disease (n = 3), and colonic carcinoma (n = 1).

Conclusion: GI complications after lung transplantation are common in patients with CF, and attention should be paid to the risk for DIOS in the early postoperative period. Prevention and early medical treatment are important in order to avoid acute surgery. Close collaboration with the CF clinic, in order to diagnose and treat CF-related complications, is recommended.


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