Routine prophylaxis with proton pump inhibitors and post‐transplant complications in kidney transplant recipients undergoing early corticosteroid withdrawal

Abstract

Surgical stress, corticosteroids, and mycophenolate may contribute to gastrointestinal ulcers/bleeding after kidney transplantation. Prophylactic acid suppression with H2RAs or PPIs is often utilized after transplantation, although unclear if truly indicated after early corticosteroid withdrawal (CSWD). PPIs have been associated with increased risks of Clostridium difficile infection (CDI), pneumonia, and acute rejection. This retrospective cohort study investigated benefits and risks of prolonged PPI use following kidney transplantation and included 286 kidney recipients undergoing CSWD within five d of transplant who were maintained on tacrolimus and mycophenolate mofetil/sodium. Patients on PPI before transplant, H2RA before/after transplant, and/or those with pre-transplant GI complications were excluded. A total of 171 patients received PPI>30 d, mean duration 287 ± 120 d (PPI group); 115 patients were not maintained on acid suppression (No-PPI group). GI ulceration and bleeding events were rare in PPI group (1.2% and 2.3%, respectively) and not observed in No-PPI group (p = NS). The incidence of infectious or hematological complications was not significantly different between groups. The PPI group experienced more biopsy-proven acute rejection (9.4% vs. 2.6%, p = 0.03). No direct benefit was observed with PPI in reducing the incidence of GI ulcers and bleeding events in kidney transplant recipients undergoing early CSWD. Further studies are needed to investigate the association of PPI and acute rejection.

Proton pump inhibitors and adverse effects in kidney transplant recipients: A meta-analysis

“…However, the clinical significance of this drug interaction in kidney transplant recipients is unknown. Several studies[20,21] have shown a possible increased risk of acute rejection with PPI exposure whereas others have not[22-24].…”

Decline in prevalence and risk of helicobacter pylori in kidney transplant recipients: A systematic review and meta‐analysis

“…The precise mechanisms resulting in the reduction in prevalence and risk of H. pylori among people with adult kidney transplant are still unclear. However, proton pump inhibitors are commonly prescribed among kidney transplant recipients . Also, kidney transplant recipients often received antibiotics prophylaxis (eg, for prevention of urinary tract infection) .…”

The association between use of proton-pump inhibitors and excess mortality after kidney transplantation: A cohort study

“…Chronic use of PPIs has tremendously increased over the past decade, and studies estimate that in both primary and hospital care 30% to 65% of patients that chronically use PPIs are using it for an inappropriate indication [57][58][59][60][61], including, e.g., corticosteroid therapy without concomitant nonsteroidal anti-inflammatory drug (NSAID) use [61,62]. Inappropriate use of PPIs may be frequent in KTRs, since PPIs are commonly prescribed to prevent gastrointestinal complaints and complications of immunosuppressive medication, particularly of corticosteroid therapy [63]. According to the Food and Drug Administration (FDA) guidelines, PPI use is not routinely indicated in this situation [64,65].…”