General surgical complications

The extracardiac complication rate following heart transplantation has been reported to be between 9.5 and 38 per cent. In one series abdominal complications after heart transplantation directly accounted for a 30-day mortality of nearly 10 per cent. Most of the extracardiac complications involve the abdomen and gastrointestinal tract and 4 to 20 per cent may require surgical intervention. The high incidence of surgical abdominal processes may be secondary to the use of immunosuppressive agents masking disease progression until relatively late. Common causes of general surgical intervention following heart transplantation include gastrointestinal bleeding, viscus perforation, pancreatitis, cholecystitis, and Clostridium difficile enterocolitis. The prevalence of these complications is far greater than in general cardiac surgical patients in part because of the added side-effects of immunosuppressive agents. Unexplained ileus or abdominal pain/tenderness, particularly with evidence of infection, mandates an aggressive work-up beginning with imaging studies of the abdomen.

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