Post-cardiac transplantation gout: Incidence of therapeutic complications

Objective: To study the clinical impact of gout treatment following cardiac transplantation. Methods: We performed an audit of all cardiac transplant recipients of the Alfred Hospital before August 1998 who lived in Victoria. Results: We studied 225 patients (81% men), with a mean post-transplant follow-up of 50.8 months (SD 36), Forty-three (19%) had pre-transplant gout, 19 recurring posttransplantation. Twenty-three patients developed gout de novo. Of the 24 patients who received allopurinol, 6 developed pancytopenia and required hospitalization. Fourteen received a change in immunosuppression: in 5 patients following pancytopenia, and in 9 to enable safe use of allopurinol. Thirty-two patients received colchicine; 5 developed neuromyopathy. Impaired renal function, diuretic use, and hypertension were more common in this sub-group. Non-steroidal antiinflammatory agents, used in 16 patients, caused serious complications in 1 patient (life-threatening peptic ulceration and hemorrhage, precipitating dialysis-dependent chronic renal failure). Conclusions: Cardiac transplant recipients, when treated for gout, are at high risk of therapeutic complications. Thus, gout treatment significantly affects care, health, and immunosuppression of these patients.