Pneumatosis Intestinalis and Active Cytomegaloviral Infection After Lung Transplantation

Mannes, G. P. M.; Meinesz, A. F.; Jagt, Eric J. van der; Boer, W.J. de; Meuzelaar, J. J.; Bij, Wim van der

doi:10.1378/chest.105.3.929

Cited by 32 publications

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“…1 Outside the neonatal period, PI is fairly uncommon. It has, however, been associated with a variety of disorders and procedures including solid organ and bone marrow transplantation, [2][3][4][5][6][7][8] steroid and other immunosuppressive medications, 1,3,8,9 ischemia, inflammatory bowel disease, intestinal obstruction, and obstructive airway disease. In addition, several concomitant infectious agents have been associated with the development of PI including cytomegalovirus (CMV), Clostridium difficile, rotavirus, human immunodeficiency virus (HIV), and other viral infectious agents.…”

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confidence: 99%

“…In addition, several concomitant infectious agents have been associated with the development of PI including cytomegalovirus (CMV), Clostridium difficile, rotavirus, human immunodeficiency virus (HIV), and other viral infectious agents. 3,4,6,7,9 PI may present in a variety of ways, ranging from an incidental finding that is clinically benign to an acute and life-threatening illness. Recently diagnosed cases of PI in our pediatric thoracic organ transplantation population prompted us to retrospectively review this group of patients and evaluate them for significant clinical outcomes as well as potential risk factors in the development of PI.…”

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Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

et al. 2002

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ABSTRACT. Objective. To review and describe pneumatosis intestinalis (PI) in children who have undergone thoracic organ transplantation and evaluate potential risk factors.Methods. We retrospectively reviewed abdominal radiographs obtained from June 1992 through September 2000 in all pediatric (age <21 years) thoracic organ recipients who survived at least 1 week after transplantation. In this group, a case was defined as an episode of radiographically confirmed PI; those without PI were assigned as controls. Variables analyzed included demographic data, gastroenteritis history (stool cultures or symptoms of gastroenteritis), and transplant-related factors (ie, graft type, rejection history, immunosuppression regimen). Significance was defined as P < .05.Results. Over this 8-year period, PI occurred in 8 (7%) of 116 patients (0.86% annual risk). No child had >1 diagnosed episode of PI. Of these 8 cases, 7 presented with 1 or more abdominal symptoms. Three of these children had rotavirus antigen isolated in their stool, 2 others were noted to have stool positive for Clostridium difficile toxin, and in the other 3, no pathogen was identified. All cases were treated with a regimen of intravenous antibiotics and total parenteral nutrition. There were no deaths; however, 1 patient developed an Aspergillus pulmonary infection during his course of antibiotic therapy, and another underwent an exploratory laparotomy without bowel resection. Significant risk factors included black race (unadjusted odds ratio: 16), younger age at presentation (age <5 years; unadjusted odds ratio: 9), higher steroid dose (steroid dose >0.5 mg/kg/d; unadjusted odds ratio: 7), and a higher tacrolimus level at presentation (tacrolimus level >1; unadjusted odds ratio: 6). PI did not occur with a steroid dose <0.4 mg/kg/d. Variables not associated with increased risk for developing PI included gender, graft type, total white blood cell count, recent antibiotic use, concurrent use of an antimetabolite, cytomegaloviral infection, past use of extracorporeal membrane oxygenation, and graft rejection history.Conclusions. Significant risk factors for the development of PI in our pediatric thoracic organ transplantation population included black race, younger age, higher daily steroid dosing, and a high tacrolimus level at presentation. In the children diagnosed with PI, there were no related deaths, significant gastrointestinal sequelae, or complications. These findings suggest that in this population, PI will often have a benign course when treated aggressively, and that steroid dosing should be reduced to <0.5 mg/kg/d whenever possible. Pediatrics 2002;109(5). URL: http://www.pediatrics.org/cgi/content/ full/109/5/e78; pediatric heart transplantation, pediatric lung transplantation, pediatric heart-lung transplantation, pneumatosis intestinalis, steroids.

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Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

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“…Although there have been rare case reports of PI developing in patients after thoracic organ transplant, 2,5 there is only one series published, which consisted of 7 patients presenting with pneumoperitoneum or PI after lung transplant. 13 The clinical presentation, radiographic appearance, and outcomes of previous case reports were quite similar to those for our 10 patients with PI.…”

Section: Discussionmentioning

confidence: 99%

“…It is seen in association with a number of diseases, but its pathogenesis is still obscure. It has shown an association with solid-organ and bone marrow transplant, [1][2][3][4][5] immunosuppressive drugs, especially steroids, 1,6,7 ischemia, intestinal obstruction, and inflammatory bowel disease. Few cases have been reported after lung transplant.…”

Section: Introductionmentioning

confidence: 99%

“…5,8 Several concomitant infections have been proposed as causative agents for the development of PI, including cytomegalovirus (CMV), Clostridium difficile, human immuno deficiency virus, and rotavirus infection. 1,2,4,7,9 Three mechanisms have been suggested to account for intramural gas: mechanical, bacterial, and pulmonary. According to the mechanical theory, a mucosal injury caused by increased intraluminal pressure causes the dissection of gas into the bowel wall (eg, endoscopic procedure, intestinal obstruction).…”

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Chandola

Laing²,

Lien³

et al. 2018

Exp Clin Transplant

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Objectives: We evaluated the incidence, clinical presentation, laboratory findings, possible causes, and outcomes associated with pneumatosis intestinalis in the setting of lung transplant. Materials and Methods: A departmental database showed that, between October 2002 and August 2013, our institution performed 373 lung transplants. The database was queried for all patients who had pneumatosis intestinalis and/or pneumoperitoneum after lung transplant at our institution. For this retrospective chart review, information collected included demographics, baseline variables, symptoms, signs, laboratory parameters, radiologic work-up, medications, including immunosuppressants at presentation, progress and time to resolution, length of hospital stay, and postoperative complications, as well as short-term and midterm outcomes (up to 1 year). Results: The incidence of pneumatosis intestinalis was 2.68% (10/373 patients). Mean age of patients was 52.2 years (range, 34.9-67.9 y). Mean time for development of pneumatosis intestinalis after transplant was 352.8 days (range, 5-2495 d). Abdominal symptoms and signs were present in 6 patients (60%). The large bowel was the site of involvement in all but 1 patient, with predilection for ascending colon (80%) and transverse colon (90%) in most patients. High serum lactate levels were found in 2 patients, and both underwent bowel resection, with surgical specimens revealing evidence of ischemic changes in the gut. Mean dose of prednisone was 22 mg at the time of presentation (range, 0-60 mg). Mean hospital length of stay was 16.9 days (range, 0-40 d). Short-term survival was 100%. Midterm survival at the end of 1 year was 80%. Mean time for pneumatosis to resolve was 18 days (range, 14-35 d). Conclusions: Pneumatosis intestinalis in bilateral lung transplant recipients can be treated with a minimal amount of imaging, and most patients can be treated conservatively. Survival outcomes are quite good, with 100% during the short term and 80% at 1 year in our series. Key words: Bowel resection, Pneumoperitoneum, Retrospective study, Survival IntroductionPneumatosis intestinalis (PI) is a bowel pathology defined as accumulation of gas in the submucosa or subserosa of the large or small intestine (Figure 1). It is seen in association with a number of diseases, but its pathogenesis is still obscure. It has shown an association with solid-organ and bone marrow transplant, 1-5 immunosuppressive drugs, especially steroids, 1,6,7

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The Spectrum of Pneumatosis Intestinalis

Peter¹

2003

Arch Surg

363

362

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A review of the spectrum of illness associated with pneumatosis intestinalis enables us to identify the probable causes of, the best diagnostic approaches to, and the most appropriate treatments for this condition. Data Sources: A review of all published material in the English language regarding pneumatosis intestinalis was conducted using the PubMed and MEDLINE databases. Any relevant work referenced in those articles and not previously found or published before the limit of the search engine was also retrieved and reviewed.Study Selection: There were no exclusion criteria for published information relevant to the topic. All of the studies cited in the present review make a point that contributes to the portrayal of this condition. In circumstances in which the same point was made in several different studies, not all were cited herein.Data Extraction: All published material on pneumatosis intestinalis was considered. Information was extracted for preferentially selected ideas and theories supported in multiple studies.Data Synthesis: The collected information was organized by theory.Conclusions: Mucosal integrity, intraluminal pressure, bacterial flora, and intraluminal gas all interact in the formation of pneumatosis intestinalis. Radiography and computed tomography are the best diagnostic tests. Nonoperative management should be pursued in most patients, and underlying illnesses should be treated. When acute complications appear, such as perforation, peritonitis, and necrotic bowel, surgery is indicated.

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Pneumatosis Intestinalis and Active Cytomegaloviral Infection After Lung Transplantation

Cited by 32 publications

References 3 publications

Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

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The Spectrum of Pneumatosis Intestinalis

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