Long-Term Management and Late Complications of the Thoracic Organ Transplant Recipient

  • D. P. Nelson
  • N. K. Imes
  • D. K. C. Cooper


The care of thoracic transplant patients centers on the use of immunosuppression to balance rejection (Chapters 8-10) against infection (Chapter 11), and on the management of these two major complications when the balance achieved is uneven. Primary care delivery to these patients is accomplished in the context of the unique toxicities and drug interactions of the immunosuppressive agents used (Chapters 8 and 10). Although some management issues directly relate to surgically altered anatomy, most are the consequence of the drugs that permit the coexistence of self with non-self.


Transplant Recipient Heart Transplant Endomyocardial Biopsy Heart Transplant Recipient Heart Lung Transplant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bexton RS, Nathan AW, Hellestrand KJ et al. Sinoatrial function after cardiac transplantation. J Am Coll Cardiol. 1984;3:712.PubMedGoogle Scholar
  2. 2.
    Bexton RS, Nathan AW, Hellestrand KJ et al. Electrophysiological abnormalities in the transplanted human heart. Br Heart J. 1983;50:555.PubMedGoogle Scholar
  3. 3.
    Heinz G, Ohner T, Laufer G, Gasic S, Laczkovics A. Clinical and electrophysiologic correlates of sinus node dysfunction after orthotopic heart transplantation. Chest. 1990;97:890.PubMedGoogle Scholar
  4. 4.
    Miyamoto Y, Curtiss El, Kormos RL et al. Bradyarrhythmia after heart transplantation. Incidence, time course, and outcome. Circulation. 1990;82:313.Google Scholar
  5. 5.
    Scoll CD, Omar IR, McComb JM, Dark JH, Bexton RS. Long-term pacing in heart transplant recipients is usually unnecessary. Pace. 1991;14:1792.Google Scholar
  6. 6.
    Cooper MM, Smith CR, Rose EA, Schneller SJ, Spotnilz HM. Permanent pacing following cardiac transplantation. J Thorac Cardiovasc Surg. 1992;104:812.PubMedGoogle Scholar
  7. 7.
    Redmond JM, Zehr KJ, Gillinov MA et al. Use of theophylline for treatment of prolonged sinus node dysfunction in human orthotopic heart transplantation. J Heart Lung Transplant. 1993;12:133.PubMedGoogle Scholar
  8. 8.
    Cook LS, Will KR, Moran J. Treatment of junctional rhythm after heart transplantation with terbutaline. J Heart Transplant. 1989;8:342.PubMedGoogle Scholar
  9. 9.
    Macdonald P, Hackworthy R, Keogh A et al. Atrial overdrive pacing for reversion of atrial flutter after heart transplantation. J Heart Lung Transplant. 1991;10:731.PubMedGoogle Scholar
  10. 10.
    Scott CD, Dark JM, McComb JM. Arrhythmias after cardiac transplantation. Am J Cardiol. 1992;70:1061.PubMedCrossRefGoogle Scholar
  11. 11.
    Vandenberg BF, Mohanty PK, Craddock KJ et al. Clinical significance of pericardial effusion after heart transplantation. J Heart Transplant. 1988;7:128.PubMedGoogle Scholar
  12. 12.
    Valantine HA, Hunt SA, Gibbons R et al. Increasing pericardial effusion in cardiac transplant recipients. Circulation. 1989;79:603.PubMedGoogle Scholar
  13. 13.
    Goldstein JA, Janu P, Fields B. Rectus femoris flap repair of recalcitrant inguinal lymphoceles after heart transplantation. J Heart Lung Transplant. 1994;13:549.PubMedGoogle Scholar
  14. 14.
    Mathes SJ, Nahia F. Sartorius muscle flap applications: coverage of groin femoral vessels and knee region. In: ?, editor. Clinical atlas of muscle and musculocutaneous flaps. St Louis, MO: Mosby: 1979:33.Google Scholar
  15. 15.
    Ragni T, Martinelli L, Goggi C et al. Echo-controlled endomyocardial biopsy. J Heart Transplant. 1990;9:538.PubMedGoogle Scholar
  16. 16.
    Baraldi-Junkins C, Levin HR, Kasper EK et al. Complications of endomyocardial biopsy in heart transplant patients. J Heart Lung Transplant. 1993;12:63.PubMedGoogle Scholar
  17. 17.
    Canedo MI. Comments on ‘complications of endomyocardial biopsy in heart trans plant patients’ (Letter). J Heart Lung Transplant. 1993;12:887.PubMedGoogle Scholar
  18. 18.
    Sutsch G, Heywood T, Turina J et al. Coronary artery-right ventricular fistula in a heart transplant patient. J Heart Transplant. 1990;9:32.PubMedGoogle Scholar
  19. 19.
    Sandhu JS, Uretsky BF, Zerbe TR et al. Coronary artery fistula in the heart transplant patient. A potential complication of endomyocardial biopsy. Circulation 1989;79:350.PubMedGoogle Scholar
  20. 20.
    Fitchett DH, Forbes C, Guerraty AJ. Repeated endomyocardial biopsy causing coronary arterial-right ventricular fistula after cardiac transplantation. Am J Cardiol. 1988;62:829.PubMedCrossRefGoogle Scholar
  21. 21.
    Henzlova MJ, Nath H, Bucy RP et al. Coronary artery to right ventricle fistula in heart transplant recipients: a complication ot endomyocardial biopsy. J Am Coll Cardiol. 1989;14:258.PubMedGoogle Scholar
  22. 22.
    Schafers HJ, Wahlers I, Borst HG. Left ventricular function, tricuspid incompetence, and incidence of coronary artery disease late after orthotopic heart transplantation. Eur J Cardiothorac Surg. 1989;3:111.PubMedCrossRefGoogle Scholar
  23. 23.
    Rees AP, Milani RV, Lavie CJ, Smart FW, Ventura HO. Valvular regurgitation and right-sided cardiac pressures in heart transplant recipients by complete Doppler and color flow evaluation. Chest. 1993;104:82.PubMedGoogle Scholar
  24. 24.
    Lewen MK, Bryg RJ, Miller LW, Williams GA, Labovitz AJ. Tricuspid regurgitation by Doppler echocardiography after orthotopic cardiac transplantation. Am J Cardiol. 1987;59:1371.PubMedCrossRefGoogle Scholar
  25. 25.
    Credle WF, Smiddy JF, Elliott RC. Complications of fiberoptic bronchoscopy. Am Rev Respir Dis. 1974;109:67.PubMedGoogle Scholar
  26. 26.
    Herf SM, Suratt PM, Arora NS. Deaths and complications associated with transbronchial lung biopsy. Am Rev Respir Dis. 1977;115:708.PubMedGoogle Scholar
  27. 27.
    Pereira W, Kovnat DM, Snider GL. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest. 1978;73:813.PubMedGoogle Scholar
  28. 28.
    Herf SM, Suratt PM. Complications of transbronchial lung biopsies. Chest. 1978;73:759.PubMedGoogle Scholar
  29. 29.
    Trulock HP, Ettinger NA, Brunt EM et al. The role of transbronchial lung biopsy in the treatment of lung transplant recipients. Chest. 1992;102:1049.PubMedGoogle Scholar
  30. 30.
    Fulkerson WJ. Fiberoptic bronchoscopy. N Engl J Med. 1984;311:511.PubMedGoogle Scholar
  31. 31.
    Scott JP, Fradet G, Smyth RL et al. Prospective study of transbronchial biopsies in the management of heart-lung and single lung transplant patients. J Heart Lung Transplant. 1991;10:626.PubMedGoogle Scholar
  32. 32.
    Lorber Ml. Cyclosporine: lessons learned — future strategies. Clin Transplant. 1991;5:505.Google Scholar
  33. 33.
    Humes HO, Jackson NM, O’Connor RP et al. Pathogenetic mechanisms of nephrotoxicity: insight into cyclosporin nephrotoxicity. Transplant Proc. 1985;17:51.PubMedGoogle Scholar
  34. 34.
    Scott JP, Nuncz D, Hay IFC et al. Exercise-induced hypertension in normotensive renal transplant recipients receiving cyclosporin A. Transplant Proc. 1987;19:4002.PubMedGoogle Scholar
  35. 35.
    English J, Evan A, Houghton DC et al. Cyclosporine-induced acute renal dysfunction in the rat: evidence of arteriolar vasoconstriction with preservation of tubular function. Transplantation. 1987;44:135.PubMedCrossRefGoogle Scholar
  36. 36.
    Jackson NM, Hsu CH, Visscher GE et al. Alterations in renal structure and function in a rat model of cyclosporin toxicity. J Pharmacol Exp Ther. 1987;242:749.PubMedGoogle Scholar
  37. 37.
    Myers BD, Newton L, Boshkos C et al. Chronic injury of human renal microves-sels with low-dose cyclosporin therapy. Transplantation. 1988;46:694.PubMedCrossRefGoogle Scholar
  38. 38.
    Mason J. The pathophysiology of Sundimmune (cyclosporin) in men and animals. Pediatr Nephrol. 1990;4:554.PubMedCrossRefGoogle Scholar
  39. 39.
    Myers BD, Ross J, Newton L et al. Cyclosporin associated chronic nephropathy. N Engl J Med. 1984;311:699.PubMedGoogle Scholar
  40. 40.
    Greeberg A, Thompson ME, Griffith BP et al. Cyclosporine nephrotoxicity in cardiac allograft patients — a seven year follow-up. Transplantation. 1990;50:589.Google Scholar
  41. 41.
    Zaltzman JS, Pey Y, Maurer J et al. Cyclosporine nephrotoxicity in lung transplant recipients. Transplantation. 1992;54:875.PubMedCrossRefGoogle Scholar
  42. 42.
    Lewis RM, Van Buren CT, Radovancevic B et al. Impact of long-term cyclosporin immunosuppressive therapy on native kidneys vs renal allografts: serial renal function in heart and kidney transplant recipients. J Heart Lung Transplant. 1991;10:63.PubMedGoogle Scholar
  43. 43.
    Waser M, Maggiorini M, Binswanger U et al. Irreversibility of cyclosporin-induced renal function impairment in heart transplant recipients. J Heart Lung Transplant. 1993;12:846.PubMedGoogle Scholar
  44. 44.
    Burke JP Jr, Pirsch JD, Ramos EL et al. Long-term efficacy and safety of cyclosporin in renal transplant recipients. N Engl J Med. 1994;331:358.PubMedCrossRefGoogle Scholar
  45. 45.
    Almond PS, Gillingham KJ, Sibley R et al. Renal transplant function after cyclosporin. Transplantation. 1992;53:316.PubMedGoogle Scholar
  46. 46.
    Van Der Heide JJH, Bilo HJG, Donker JM et al. Effect of dietary fish oil on renal function and rejection in cyclosporin-treated recipients of renal transplants. N Engl J Med. 1993;329:769.PubMedCrossRefGoogle Scholar
  47. 47.
    Markewitz A, Hammer C, Pfeiffer M et al. Reduction of cyclosporin-induced nephrotoxicity by cilastatin following clinical heart transplantation. Transplantation. 1994;57:865.PubMedCrossRefGoogle Scholar
  48. 48.
    Moran M, Mozes MF, Maddux MS et al. Prevention of acute graft rejection by the prostaglandin E-I analogue misoprostol in renal transplant recipients treated with cyclosporin and prednisone. N Engl J Med. 1990;322:1183.PubMedGoogle Scholar
  49. 49.
    Adams MB and the Enisoprost Renal Study Group. Enisoprost in renal transplantation. Transplantation. 1992;53:338.PubMedGoogle Scholar
  50. 50.
    Wilke ME, Beer JC, Newman D et al. Evidence that the risks of Misoprostol outweigh its benefits in stable cyclosporin-treated renal allograft recipients. Transplantation. 1992;54:565.Google Scholar
  51. 51.
    Bianco JA, Almgren J, Kern DL et al. Evidence that oral pentoxifylline reverses acute renal dysfunction in bone marrow transplant recipients receiving amphotericin B and cyclosporin. Transplantation. 1991;5l:925.Google Scholar
  52. 52.
    Bennett WM, Elzinga LW, Porter GA et al. The effects of pentoxifylline on experimental chronic cyclosporin nephrotoxicity. Transplantation. 1992;54:1118.PubMedGoogle Scholar
  53. 53.
    Tomlanovich S, Golbetz H, Perlroth M et al. Limitations of creatinine and quantifying the severity of cyclosporin-induced chronic nephropathy. Am J Kidney Dis. 1986;8:332.PubMedGoogle Scholar
  54. 54.
    Germain MJ, Lipkowitz GS, Guarnera J et al. A comparison of different methods of estimating glomerular filtration rate in cyclosporin-treated renal transplant patients. Transplantation. 1993;55:203.PubMedGoogle Scholar
  55. 55.
    Lewis R, Kerr N, Van Buren C et al. Comparative evaluation of urographic contrast media, inulin, and 99mTc-DTPA clearance methods for determination of glomerular filtration rate in clinical transplantation. Transplantation. 1989;48:790.PubMedCrossRefGoogle Scholar
  56. 56.
    Jarowenko M, Flechner SM, Van Buren CT, Lorber MI, Kahan BD. Influence of cyclosporin on posttransplant blood pressure response. Am J Kidney Dis. 1987;10:98.PubMedGoogle Scholar
  57. 57.
    Lasko D, Curtis JJ. Post-transplant hypertension. Am J Hypertens. 1990;3:721.Google Scholar
  58. 58.
    Olivari MT, Antolick A, Ring WS. Arterial hypertension in heart transplant recipients treated with triple-drug immunosuppressive therapy. J Heart Transplant. 1989;8:34.PubMedGoogle Scholar
  59. 59.
    Scherrer U, Vissing SF, Morgan BJ et al. Cyclosporine-induced sympathetic activation and hypertension after heart transplantation, N Engl J Med. 1990;323:693.PubMedGoogle Scholar
  60. 60.
    Valentine H, Keogh A, McIntosh N et al. Cost containment: co-administration of diltiazem with cyclosporin after heart transplantation. J Heart Lung Transplant. 1992;11:1.Google Scholar
  61. 61.
    Bunkey M, Ganzel B. Effective calcium channel antagonisms on renal function in hypertensive heart transplant recipients. J Heart Lung Transplant. 1992;11:1194.Google Scholar
  62. 62.
    Bennett WM, Myer MM. Considerations in the medical management of hypertension and cyclosporin A treated allograft recipients (Letter). Transpl. Immunol. 1992;8:4.Google Scholar
  63. 63.
    Angerman CE, Spes CH, Willems S et al. Circadian behavior of blood pressure and heart rate following orthotopic heart transplantation. Studies before and during antihypertensive therapy. Z Kardiol. 1989;78:228.Google Scholar
  64. 64.
    Dunn DH, Hoffman FM, General surgical diseases after cardiopulmonary transplantation. Cardiac Surg State Art Rev. 1989;3:653.Google Scholar
  65. 65.
    Villar HV, Neal DD, Levinson M et al. Gastrointestinal complications after human transplantation and mechanical heart replacement. Am J Surg. 1989;157:168.PubMedCrossRefGoogle Scholar
  66. 66.
    Jones MT, Menkis AH, Kostuk WJ, McKenzic FN. Management of general surgical problems after cardiac transplantation. Can J Surg. 1988;31:259.PubMedGoogle Scholar
  67. 67.
    Disesa VJ, Kirkman RL, Tilney NL et al. Management of general surgical complications following cardiac transplantation. Arch Surg. 1989;124:539.PubMedGoogle Scholar
  68. 68.
    Aziz S, Bergdahl L, Baldwin JC et al. Pancreatitis after cardiac and cardiopulmonary transplantation. Surgery. 1985;97:653.PubMedGoogle Scholar
  69. 69.
    Sleek TB, Durkin MG, Costanzo-Nordin MR, Keshavarzian A. Gastrointestinal complications and endoscopic findings in heart transplant patients. J Heart Lung Transplant. 1993;12:244.Google Scholar
  70. 70.
    Merrell SW, Ames SW, Nelson EW et al. Major abdominal complications following cardiac transplantation. Utah Transplantation Affiliated Hospitals Cardiac Transplant Program. Arch Surg. 1989;124:889.PubMedGoogle Scholar
  71. 71.
    Smith PC, Slaughter MS, Petty MG et al. Abdominal complications after lung transplantation. J Heart Lung Transplant. 1995;14:44.PubMedGoogle Scholar
  72. 72.
    Kaplan CS, Petersen EA, Icenogle TB et al. Gastrointestinal cytomegalovirus infection in heart and heart-lung transplant recipients. Arch Intern Med. 1989;149:2095.PubMedCrossRefGoogle Scholar
  73. 73.
    Merigan TC, Renlund DG, Keay S et al. A controlled trial of ganciclovir to prevent cytomegalovirus disease after heart transplantation. N Engl J Med. 1992;326:1182.PubMedGoogle Scholar
  74. 74.
    Buckner FS, Pomeroy C. Cytomegalovirus disease of the gastrointestinal tract in patients without AIDS. Clin Infec Dis. 1993;17:644.Google Scholar
  75. 75.
    Van Thiel D, Gavaler JS, Schade RR, Chien MC, Starzl TE. Cytomegalovirus infection and gastric emptying. Transplantation. 1992;54:70.PubMedGoogle Scholar
  76. 76.
    Franzin G, Muolo A, Griminelli T. Cytomegalovirus inclusions in the gastroduodenal mucosa of patients after renal transplantation. Gut. 1981;22:698.PubMedGoogle Scholar
  77. 77.
    Graham DY. Treatment of peptic ulcers caused by Helicobacter pylori. N Engl J Med. 1993;328:349.PubMedCrossRefGoogle Scholar
  78. 78.
    Teenan RP, Burgoyne M, Brown IL, Murray WE. Helirobacter pylori in renal transplant recipients. Transplantation. 1993;56:100.PubMedCrossRefGoogle Scholar
  79. 79.
    Parsonnet J, Hansen S, Rodriguez L et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med. 1994;330:1267.PubMedCrossRefGoogle Scholar
  80. 80.
    Mosimann F. Esophageal candidiasis, omeprazole therapy, and organ transplantation — a word of caution (Letter). Transplantation. 1993;56:492.PubMedCrossRefGoogle Scholar
  81. 81.
    Steck TB, Costanzo-Nordin MR, Keshavarzian A. Prevalence and management of cholelithiasis in heart transplant patients. J Heart Lung Transplant. 1991;10:1029.PubMedGoogle Scholar
  82. 82.
    Peterseim DS, Chesnut LC, Meyers CH et al. Stability of the beta-adrenergie receptor/adenyl cyclase pathway of pediatric myocardium after brain death. J Heart Lung Transplant. 1994;13:635.PubMedGoogle Scholar
  83. 83.
    Sharobeem R, Bacq Y, Furet Y et al. Cyclosporine A and ursodeoxycholic acid interaction. Clin Trans. 1993;7:223.Google Scholar
  84. 84.
    Adiseshiah M, Wells FC, Cory-Pearce R, Wallwork J, English TA. Acute pancreatitis after cardiac transplantation. World J Surg. 1983;7:519.PubMedCrossRefGoogle Scholar
  85. 85.
    Fernandez JA, Rosenberg JC. Post-transplantation pancreatitis. Surg. Gynecol. Obstet. 1976;143:795.PubMedGoogle Scholar
  86. 86.
    Mallory A, Kern F. Drug-induced pancreatitis: a critical review. Gastroenterology. 1980;78:813.PubMedGoogle Scholar
  87. 87.
    Fernandez-Del Castillo C, Harringer W, Warshaw AL et al. Risk factors for pancreatic cellular injury after cardiopulmonary bypass. N Engl J Med 1991;325:382.Google Scholar
  88. 88.
    Taft PM, Jones AC, Collins GM, Halasz NA. Acute pancreatitis following renal allotransplantation. A lethal complication. Am J Dig Dis. 1978;23:541.PubMedCrossRefGoogle Scholar
  89. 89.
    Johnson WC, Nabseth DC. Pancreatitis in renal transplantation. Ann Surg. 1970;171:309.PubMedGoogle Scholar
  90. 90.
    Williams G, Kyriakidis A, Gastro JE. Pancreatitis complicating renal transplantation. J R Coll Surg Edin. 1981;26, 184.Google Scholar
  91. 91.
    Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med. 1994;330:1198.PubMedCrossRefGoogle Scholar
  92. 92.
    Church JM, Fazio VW, Braun WE, Novick AC, Steinmuller DR. Perforation of the colon in renal homograft recipients, A report of 11 cases and a review of the literature. Ann Surg. 1986;203:69.PubMedCrossRefGoogle Scholar
  93. 93.
    Squiers EC, Pfaff WW, Patton PR, Howard RJ. Early posttransplant colon perforation: does it remain a problem in the cyclosporin era? Transplant Proc. 1991;23:1782.PubMedGoogle Scholar
  94. 94.
    Koneru B, Selby R, O’Hair DP et al. Nonobstructing colonic dilatation and colon perforations following renal transplantation. Arch Surg. 1990;125:610.PubMedGoogle Scholar
  95. 95.
    Ballantyne CM, Jones PH, Payton-Ross C et al. Hyperlipidemia following heart transplantation: natural history and intervention with mevinolin (lovastatin). Transplant Proc. 1987;19:60.PubMedGoogle Scholar
  96. 96.
    Taylor DO, Thompson JA, Hastillo A et al. Hyperlipidemia after clinical heart transplantation. J Heart Transplant. 1989;8:209.PubMedGoogle Scholar
  97. 97.
    Ballantyne CM, Radovancevie B, Farmer JA et al. Hyperlipidemia after heart transplantation: report of a 6-year experience with treatment recommendations. J Am Coll Cardiol. 1992;19:1315.PubMedGoogle Scholar
  98. 98.
    Becker DM, Chamberlain B, Swank R et al. Relationship between corticosteroid exposure and the plasma lipid levels in heart transplant recipients. Am J Med 1988;85:632.PubMedGoogle Scholar
  99. 99.
    Ballantyne CM. Lipids and cyclosporin A. Transplant Immunol Lett. 1992;8:4.Google Scholar
  100. 100.
    Rader JI, Calvcrt RJ, Hathcock JN et al. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med. 1992;92:77.PubMedCrossRefGoogle Scholar
  101. 101.
    Pflugfelder PW, Huff M, Oskalns R, Rudas L, Kostuck WJ. Cholesterol-lowering therapy after heart transplantation: a 12 month randomized trial. J Heart Lung Transplant. 1995;14:613.PubMedGoogle Scholar
  102. 102.
    Kobashigawa JA, Murphy FL, Stevenson LW et al. Low-dose lovastatin safely lowers cholesterol after cardiac transplantation. Circulation. 1990;82(Suppl. IV):IV–281.Google Scholar
  103. 103.
    Kohashigawa JA, Katznelson S, Laks H et al. Effect of pravastatin on outcomes after cardiac transplantation. N Engl J Med. 1995;333:621.CrossRefGoogle Scholar
  104. 104.
    Kuo PC, Kirshenbaum JM, Gordon J et al. Lovastatin therapy for hypercholesterolenmia in cardiac transplant recipients. Am J Cardiol. 1989;64:631.PubMedCrossRefGoogle Scholar
  105. 105.
    Pierce LR, Wysowski DK, Gross TP. Myopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy. J Am Med Assoc. 1990;264:71.CrossRefGoogle Scholar
  106. 106.
    Reaven P, Wilztum JL, Lovastatin. nicotinic acid and rhabdomyolysis. Ann Intern Med. 1988;109:597.PubMedGoogle Scholar
  107. 107.
    Muchmore JS, Cooper DKC, Ye Y et al. Prevention of loss of vertebral bone density in heart transplant patients. J Heart Lung Transplant. 1992;11:959.PubMedGoogle Scholar
  108. 108.
    Sumbrook PN, Kelly PJ, Keogh AM et al. Bone loss after heart transplantation: a prospective study. J Heart Lung Transplant. 1994;13:116.Google Scholar
  109. 109.
    Lee AH, Mull RL, Keenan GF et al. Osteoporosis and bone morbidity in cardiac transplant recipients. Am J Med. 1994;96:35.PubMedCrossRefGoogle Scholar
  110. 110.
    Shane E, Rivas MC, Silverberg SJ et al. Osteoporosis after cardiac transplantation. Am J Med. 1993;94:257.PubMedCrossRefGoogle Scholar
  111. 111.
    Rich CM, Mudge GH, Laffel GL, Leboff MS. Cyclosporine A and prednisone-associated osteoporosis in heart transplant recipients. J Heart Lung Transplant. 1992;11:950.PubMedGoogle Scholar
  112. 112.
    Meys E, Bone loss after orthotopic liver transplantation. Am J Med. 1994;97:445.PubMedCrossRefGoogle Scholar
  113. 113.
    Grotz WH. Mundinger FA. Gugel B et al. Bone fracture and osteodensitometry with dual energy X-ray absorptiometry in kidney transplant recipients. Transplantation. 1994;58:912.PubMedCrossRefGoogle Scholar
  114. 114.
    Lukert BP, Raisz LG. Glueocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990;112:352.PubMedGoogle Scholar
  115. 115.
    Seeman E, Wanner HW, Offord KP et al. Differential effects of endocrine dysfunction on the axial and appendicular skeleton. J Clin Invest. 1982;69:1302.PubMedCrossRefGoogle Scholar
  116. 116.
    Katz IA, Epstein S. Post-transplantation bone disease. J Bone Min Res. 1992;7:123.Google Scholar
  117. 117.
    Dumoulin G, Hory B, Nguyen NU et al. Lack of evidence of cyclosporin treatment impairs calcium-phosphorus homeostasis and bone remodeling in normocalcemic long-term renal transplant recipients. Transplantation. 1995;59:1690.PubMedCrossRefGoogle Scholar
  118. 118.
    Baylink JD. Glucocorticoid-induced osteoporosis. N Engl J Med. 1983;309:306.PubMedGoogle Scholar
  119. 119.
    Johnston CC Jr, Slemenda CW. Risk assessment: theoretical considerations. Am J Med. 1993;95:2S.Google Scholar
  120. 120.
    Rivas C, Silverberg SJ, Kim T et al. Osteopenia in cardiac transplant recipients. J Bone Min Res. 1991:6(S1)(abstract 93).Google Scholar
  121. 121.
    Ross CS. Monitoring L-thyroxine therapy: lessons from the effects of L-thyroxine on bone density (Editorial). Am J Med. 1991;91:1.PubMedCrossRefGoogle Scholar
  122. 122.
    Kapsner P, Langsdorf L, Marcus R, Kraemer FB, Hoffman AR. Milk-alkali syndrome in patients treated with calcium carbonate after cardiac transplantation. Arch Intern Med. 1986;146:1965.PubMedCrossRefGoogle Scholar
  123. 123.
    Diamond T. McGuigan L. Barbagallo S. Bryant C. Cyclical etidronate plus ergocalciferol prevents glueocorticoid-induced bone loss in postmenopausal women. Am J Med. 1995;98:459.PubMedCrossRefGoogle Scholar
  124. 124.
    Chesnut CH, McClung MR, Ensrud KE et al. Alendronate treatment of the post-menopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med. 1995;99:144.PubMedCrossRefGoogle Scholar
  125. 125.
    Gennari C. Effects of deflazacort on bone. In: Peck A, ed. Minimizing the risks of glucocorticoid-induced bone loss. Stamford: GEM Communications; 1993;16.Google Scholar
  126. 126.
    Isono SS, Woolson ST, Schurman DJ. Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients. Clin Orthoped. 1987;217:201.Google Scholar
  127. 127.
    Rozenberg S, Frih L, Lang T et al. Rhcumatological complications in heart transplant recipients. Rev Rheum. 1993;60:11.Google Scholar
  128. 128.
    Harrington KD, Murray WR, Kountz SL et al. Avascular necrosis of bone after renal transplantation. J Bone J Surg (Am). 1971;53A:203.Google Scholar
  129. 129.
    Sten PJ. Watts HG. Osteonecrosis after renal transplantation in children. J Bone J Surg (Am). 1979;61:581.Google Scholar
  130. 130.
    Enright H, Haake R, Weisdorf D et al. Avascular necrosis of bone: a common serious complication of allogeneic bone marrow transplantation. Am J Med. 1990;89:733.PubMedCrossRefGoogle Scholar
  131. 131.
    Feletti C, Di Felice A, Scolari MP, Bonomini V. Glucocorticoids and avascular bone necrosis in renal transplantation. Adv Exp Med Biol. 1984;171:361.PubMedGoogle Scholar
  132. 132.
    Patton PR, Pfaff WW. Aseptic bone necrosis after renal transplantation. Surgery. 1988;103:63.PubMedGoogle Scholar
  133. 133.
    Elmstedt E. Avascular bone necrosis in the renal transplant patient: a discriminate analysis of 144 patients. Clin Orthoped. 1981;158:149.Google Scholar
  134. 134.
    Felson DT, Anderson JJ. A cross-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet. 1987;1:902.PubMedCrossRefGoogle Scholar
  135. 135.
    Burack DA, Griffith BP, Thompson ME, Kahl LE. Hyperuricemia and gout among heart transplant recipients receiving cyclosporin. Am J Med. 1992;92:141.PubMedCrossRefGoogle Scholar
  136. 136.
    Kahl LE, Thompson ME, Griffith BP. Gout in the heart transplant recipient: physiologic puzzle and therapeutic challenge. Am J Med. 1989;87:289.PubMedCrossRefGoogle Scholar
  137. 137.
    West C, Carpenter BJ, Hakala TR. The incidence of gout in renal transplant recipients. Am J Kidney Dis. 1987;10:369.PubMedGoogle Scholar
  138. 138.
    Rodnan GP. Treatment of gout and other forms of crystal-induced arthritis. Bull Rheumatol Dis. 1982;32:43.Google Scholar
  139. 139.
    Van Thiel DH, Iqbal M, Jain A et al. Gastrointestinal and metabolic problems associated with immunosuppression with either cyclosporin or FK506 in liver transplantation. Transplant Proc. l990;22(Suppl. l):37.Google Scholar
  140. 140.
    Penn I, Makowski EL, Parenthood in kidney and liver transplant recipients. Transplant Proc. 1981;13:36.PubMedGoogle Scholar
  141. 141.
    Crosnier J, Broyer M. Treatment of chronic renal failure in children. In: Hamburger J. Crosnier J. Grunfield JP, editors. Nephrology. New York: Wiley: 1979:1361.Google Scholar
  142. 142.
    Blodgett FM, Burgin L. Tezzoni D, Oribetz D, Talbot NB. Effects of prolonged cortisone therapy on the statural growth, skeletal maturation and metabolic status of children. N Engl J Med. 1956;254:636.PubMedCrossRefGoogle Scholar
  143. 143.
    Soyka LF, Saxena KM. Alternate-day steroid therapy for nephrotic children. J Am Med Assoc. 1965;192:225.Google Scholar
  144. 144.
    Potter DE, Holliday MA, Wilson CJ. Salvatierra O. Belzer FO. Alternate-day steroids in children after renal transplantation. Transplant Proc. 1975;7:79.PubMedGoogle Scholar
  145. 145.
    Debnath SC, Abomelha MS, Jawdat M, Chang R, Al-Khader AA. Ocular side effects of systemic steroid therapy in renal transplant patients. Ann Ophthalmol. 1987;19:435.PubMedGoogle Scholar
  146. 146.
    Luntz MH, Clinical types of cataracts. In: Duane TD, editor. Duane’s series of ophthalmology, vol.1. Philadelphia, PA: Lippincott. 1980;15.19.Google Scholar
  147. 147.
    Koranda FC, Dehmel EM, Kahin G, Penn I. Cutaneous complications in immuno-suppressed renal homograft recipients. J Am Med Assoc. 1974;229:419.CrossRefGoogle Scholar
  148. 148.
    Spencer ES, Anderson HK. Clinically evident, non-terminal infections with herpes viruses and the wart virus in immunosuppresed renal allograft recipients. Br Med J. 1970;3:251.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • D. P. Nelson
  • N. K. Imes
  • D. K. C. Cooper

There are no affiliations available

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