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Purpose: The incidence of gastrointestinal (GI) complications after Lung Transplantation (LTx) is not well described. This study attempts to identify the incidence of GI complications after LTx, characterize the risk factors that lead to GI complications, and then determine the impact of GI complications on post-transplant outcomes.
Methods: A prospective database of patients who underwent LTx between 2005 and 2011 was queried. Generalized linear regression was used to determine risk factors for developing GI complications. A multivariable Cox regression model was developed to predict the impact of GI complications and other factors on the survival of these patients.
Results: During the study period 543 patients underwent LTx. 137 GI complications (Table 1) occurred in 124 of these patients. 62 of these patients subsequently underwent operative management of their GI complication. Patients who had a GI complication had a statistically significant worse 5 year survival (51% vs 65%) when compared to those who did not have a GI complication (p=0.006) ( Figure 1). On univariable analysis, having a diagnosis of cystic fibrosis (p=0.03), ischemic time (p=.05), total length of stay (LOS) (p=0.0008), total ICU days (p=0.0004) and an elevated FK level (p=.005) were associated with having a GI complication after transplantation. On multivariable analysis, total ICU days (OR= 1.005, 95% CI 1.003-1.007) was an independent factor associated with having a GI complication.
Conclusions: There is a high incidence of GI complications in patients who undergo LTx. Recipients who suffer a GI complication after LTx have diminished overall survival. Total ICU days was an independent factor associated with having a GI complication.
GI Complication Incidence

N=124 patients	Total Number	Number that went to OR
C diff colitis	26 (19%)	0
Biliary	22 (16%)	20 (91%)
Perforation/Leak	13 (9.5%)	10 (76.9%)
Diverticulitis	11 (8%)	9 (81.8%)
GI Bleed	10 (7.3%)	0
Gastroduodenal ulcer	9 (6.6%)	0
Esophageal candidiasis	9 (6.6%)	0
Slipped Nissen	6 (4.4%)	6 (100%)
SBO	5 (3.6%)	4 (80%)
Bleed -Non-GI	5(3.6%)	3 (50%)
Ischemic Colitis	4 (3%)	2 (50%)
Retroperitoneal abscess	2 (1.5%)	2 (100%)
Eneterocutaneous Fistula	2 (1.5%)	1 (50%)
Miscellaneous	13 (9.5%)	5 (38.5%)
Total	137	62 (46%)