**13. Gastrointestinal complications unique to transplant recipients and immunosuppression**

Immunosuppressive regimens administered to transplant recipients predispose this patient population to elevated risk for bacterial, fungal, parasitic, and viral infections [65]. Within this broad pathophysiologic spectrum, gastrointestinal infection and associated manifesta‐ tions feature prominently. While a complete discussion of this topic is beyond the scope of this chapter, we thought it would be important to mention some of the more prominent among these post-transplant sequelae. The list of potential gastrointestinal complications seen after solid organ transplantation is diverse, including cytomegalovirus enteritis [65], herpes simplex virus mucocutaneous manifestations [66], candidal esophagitis [67], *Clostri‐ dium difficile* and *Yersinia enterocolitica* infections [4], parasitic (protozoan/metazoan) enteritis [67], and *Helicobacter pylori* infection [68]. Among other post-transplant gastrointestinal com‐ plications, organ recipients may be more likely to exhibit diarrhea, luminal ulcerations, per‐ forations, biliary tract complaints, pancreatitis, and gastrointestinal malignancy (i.e., posttransplant lymphoproliferative disorder) [65, 69]. For more detail regarding post-transplant and immunosuppresion-related gastrointestinal complications among heart and lung recipi‐ ents, the reader is referred to more specialized literature on this expansive topic [65, 67, 68].

inguinal, diaphragmatic), peritoneal fluid leaks, and mesenteric ischemia [75, 79-83]. Of note, gastrointestinal hemorrhage has also been reported in patients with ventricular assist devices [84, 85], with higher bleeding rates seen among recipients of non-pulsatile devices as compared to pulsatile devices [86]. There is a trend toward higher mortality among patients receiving ventricular assist devices who experience abdominal complications [75]. Intraaortic balloon pumps are among known risk factors for gastrointestinal complications fol‐ lowing CTS [8, 32]. Some of the reported GIC associated with intra-aortic balloon pump use

Gastrointestinal Complications in Cardiothoracic Surgery: A Synopsis

http://dx.doi.org/10.5772/54348

365

Gastrointestinal complications following cardio-thoracic procedures continue to significant‐ ly contribute to morbidity and mortality in this patient population. Preventive strategies, coupled with early recognition and aggressive management of GIC-CTS constitute the foun‐ dation of the general clinical approach to these complications. Therefore, it is imperative that all practitioners who care for postoperative cardiac and thoracic surgical patients are fa‐ miliar with the full spectrum of potential gastrointestinal complications in this patient popu‐

1 Department of Surgery, The Ohio State University College of Medicine, Columbus Ohio,

2 Division of Critical Care Trauma and Burn, The Ohio State University College of Medicine,

3 Department of Radiology, Section of Interventional Radiology, The Ohio State University

[1] Andersson, B, et al. Gastrointestinal complications after cardiac surgery. Br J Surg,

[2] Zacharias, A, et al. Predictors of gastrointestinal complications in cardiac surgery.

and Stanislaw P. A. Stawicki1,2

include gastrointestinal bleeding, bowel ischemia, and pancreatitis [78, 87, 88].

lation, as well as with general therapeutic approaches to these complications.

, David E. Lindsey1,2, Hooman Khabiri3

**15. Conclusions**

**Author details**

Jennifer Schwartz1

Columbus Ohio, USA

**References**

College of Medicine, Columbus Ohio, USA

Tex Heart Inst J, (2000). , 93-99.

(2005). , 326-333.

USA
