Gastrointestinal Complications in Heart Transplant Patients: MITOS Study B. DÍaz, F. González Vilchez, L. Almenar, J.F. Delgado, N. Manito, M.J. Paniagua, M.G. Crespo, E. Kaplinsky, D.A. Pascual, J. Fernández-Yáñez, S. Mirabet, and J. Palomo for the MITOS Study Group ABSTRACT Introduction. The most frequent immunosuppressive treatment complications in solid organ transplant recipients are gastrointestinal (GI) disorders. Materials and Methods. An observational, cross-sectional study to evaluate the preva- lence and management of GI complications in transplanted patients was conducted via a written questionnaire given to doctors at their practice. Results. This study included 1788 patients; 181 corresponded to heart transplant recipients. The mean age for the heart transplant patients was 58.7  11.8 years. The mean time from the transplantation was 5.2  4.4 years. GI complications were seen in 38.7% of cases. Regarding the clinical management, in 72.9% of cases patients with GI complications received pharmacologic treatment, 86.3% with gastric protectors, 32.8% reduced the dose of some drug, 8.1% interrupted the drug temporarily, and 10.9% discontinued the drug permanently. The drug that was always discontinued was mycophe- nolate mofetil (MMF), and in 85.7% of cases in which the dose of an immunosuppressive drug was reduced, the reduced drug was also MMF. Conclusions. Almost 40% of heart transplant recipients suffered GI complications which affected daily activities in most cases. The most used strategy to manage these complications was based on a treatment with gastric protectors together with dose reduction and/or partial or definitive MMF discontinuation. G ASTROINTESTINAL (GI) COMPLICATIONS are common in solid organ transplant recipients. These complications can range from a mild to moderate disease like diarrhea or nausea to more severe and life-threatening ones like colon perforation, digestive bleeding, or others. GI complications are frequently caused by infections in- duced by opportunistic organisms. However, they might also occur due to mechanical damage during surgery or to metabolic or organ toxicity related to immunosuppressive treatments. Immunosuppressive drugs can cause GI com- plications by either direct action on the intestine or by increasing patient vulnerability to infectious agents. After transplantation it is often difficult to distinguish whether the GI complications are related to infection or to immunosup- pression. 1–3 Since failure to identify evolving (but initially asymptomatic) conditions may have a life-threatening out- come, suspicious GI findings— even apparently mild ones— should be studied carefully. 1 Most immunosuppressive treatments are associated with some type of GI complication which can be classified into several general categories: infectious, mucosal injury/ulcer- ation, biliary tract diseases, diverticular disease, pancreati- tis, or malignancy. 1 Although some GI complications impair From the Hospital Central de Asturias, Oviedo, Spain (B.D.-M.); Hospital Marqués de Valdecilla, Santander, Spain (F.G.V.); H. La Fe, Valencia, Spain (L.A.); H. 12 de Octubre, Madrid, Spain (J.F.D.); H. Bellvitge, Hospitalet de Llobregat, Barcelona, Spain (N.M.); H. Juan Canalejo, A Coruña, Spain (M.J.P., M.G.C., M.D.I.T.); Hospital Sant Pau, Barcelona, Spain (E.K., S.M.); H. Virgen de la Arrixaca, Murcia, Spain (D.A.P.); and Hospital Gregorio Marañon, Madrid, Spain (J.F.-Y., J.P.). This study was supported by Novartis. Address reprint requests to Dr Beatriz DÍaz-Molina, Hospital Universitario Central de Asturias, Heart Transplant Unit–Cardiology Department, C/Julián Claveria s/n, 33006 Oviedo, Spain. E-mail: beadimo@gmail.com © 2007 by Elsevier Inc. All rights reserved. 0041-1345/07/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2007.07.061 Transplantation Proceedings, 39, 2397–2400 (2007) 2397