Gastrointestinal complications in renal transplant recipients

Abstract

Summary Gastrointestinal complications are frequent in renal transplant recipients and can include oral lesions, esophagitis, peptic ulcer, diarrhea, colon disorders and malignancy. Oral lesions may be caused by drugs such as cyclosporine and sirolimus, by virus or fungal infections. Leukoplakia may develop in patients with Epstein–Barr virus (EBV) infection. The commonest esophageal disorder is represented by fungal esophagitis usually caused by candida. A number of patients may suffer from nausea, vomiting and gastric discomfort. These disorders are more frequent in patients treated with mycophenolate mofetil (MMF). Peptic ulcer is more rare than in the past. Patients with a history of peptic ulcer are particularly prone to this complication. Other gastroduodenal disorders are caused by cytomegalovirus (CMV) and herpes simplex infection. Diarrhea is a frequent disorder which may be caused by pathogen microorganisms or by immunosuppressive agents. The differential diagnosis may be difficult. Colon disorders mainly consist of hemorrhage, usually sustained by CMV infection, or perforation which may be caused by diverticulitis or intestinal ischemia. Colon cancer, anal carcinoma, and EBV‐associated lymphoproliferative disorders are particularly frequent in transplant recipients. A particular gastric lymphoma called mucosa‐associated lymphoid tissue (MALT) lymphoma may develop in renal transplant patients. It usually responds to the eradication of Helicobacter pylori.

Gastrointestinal Side Effects of Post-Transplant Therapy

“…Although the overall incidence is lower than in other periods of evolution of the post-transplant immunosuppression treatment, these ulcers tend to occur at varying and unpredictable intervals. Moreover, the diagnosis itself is dimmed and complicated because of the fact that steroid administration is actually masking the clinical symptoms of ulcer and of other GI disorders, thereby delaying the diagnosis and the treatment of lesions [5]. In fact, many of the ulcerative lesions in transplanted patients are entirely asymptomatic.…”

“…Therefore, this requires a high degree of clinical suspicion and also a low threshold of endoscopy indication with histology, microbiology and virology harvesting when we suspect this type of pathology [5]. Although there are transplant groups who perform routine digestive endoscopy in the postoperative evolution of transplanted patients (in the 7th and 14th day), even if H2 antagonists or proton pump inhibitors (PPIs) are used, the overall impression is that these maneuvers are aggressive and recommended only in specific cases.…”

“…For the prophylaxis of fungal infection of the upper digestive tract, nystatin is usually used, which is given orally every 6 hours for a period of 6 months and especially after the initiation of the treatment of acute rejection crisis. Clotrimazole or amphotericin B can also be administered orally, particularly in patients with kidney transplantation, in whom the treatment has the same effectiveness [5].…”

“…However, this success comes with a price: multiple side effects of the immunosuppressive drug therapy. Many of these complications occur in the gastrointestinal (GI) tract [1][2][3][4][5][6].…”

Gastric hyperplastic polyps in post transplant patients: a clinicopathologic study

“…1,2 Gastric complications include peptic ulcer disease, posttransplant lymphoproliferative disorders, graft-versus-host disease and infection and may be linked to medication, infection or exacerbation of pre-existing lesions. 1,2 An uncommon occurrence in the general population, the development of gastric hyperplastic polyps in the solid organ transplant recipient recently has been described. 3 Hyperplastic polyp is one of the most common gastric epithelial polyps.…”