Prophylaxis of acute gastroduodenal bleeding after renal transplantation

Abstract

Severe gastroduodenal bleeding after renal transplantation is effectively prevented by H2 receptor blockers. New drugs for prophylaxis include proton pump inhibitors. The aim of the present study was to compare the effects of prophylaxis with the H2 blocker ranitidine and with the proton pump inhibitor omeprazole. One hundred seventy-seven consecutive patients were included in a controlled, prospective, randomized study after cadaveric renal transplantation. In one case, ranitidine failed to prevent exsanguination due to duodenal peptic ulcer bleeding. No bleeding was noted in the omeprazole group. There were no significant differences between the groups in hospitalization time, development of renal function, amount of cyclosporin A, prednisone, azathioprine, or methylprednisoline ingested, or laboratory biochemical parameters. We conclude that prophylaxis of severe gastroduodenal bleeding after renal transplantation with omeprazole is effective. Omeprazole is certainly as good as ranitidine; its advantages are a prolonged effect and a simple dosage, independent of graft function development.

Prophylaxis for stress-related gastrointestinal hemorrhage

“…Some authors have prescribed an oral/nasogastric regimen of simplified omeprazole suspension (40 mg twice on the first day and 20 mg per day thereafter [32,33]). Special points The single trial that compared omeprazole to another agent did not show a significant difference in the efficacy of omeprazole as compared to ranitidine [34]. Contraindications Known allergy to this class of agents.…”

Upper gastrointestinal complications after renal transplantation: a 3‐yr sequential study

“…The 1980s saw the frequency of complications drop to 7%, although the laparotomy and mortality rates in these patients remained around the same level (9–15). Publications in the 1990s have indicated a 6% prevalence of foregut complications, laparotomy and mortality rates in the patients with complications being <5% in most series (16–21).…”

“…Skala et al. (21) found no difference in the frequency of foregut complications after renal transplantation in 177 patients randomized to either ranitidine or omeprazole and concluded that both therapies were equally effective. Our findings support this, no difference in the frequency of complications being seen between our patients treated with omeprazole and those treated with ranitidine.…”

Peptic Ulcer Disease

“…The use of cyclosporine (ciclosporin), antiviral therapy, and early diagnosis and treatment appear to have had beneficial effects, although the incidence of PUD remains increased and peptic ulcers are still an important source of morbidity in this population [159,160]. The value of pretransplant screening is controversial and antiulcer prophylaxis is routine in most centers [162]. Chen et al [161] observed two risk factors for peptic ulcer in transplant patients: methylprednisolone pulse therapy and a pretransplantation history of PUD.…”