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

Abstract

We observed a low frequency (8%) of upper gastrointestinal tract complications after renal transplantation. There was no difference in the frequency of complications between patients on tacrolimus and those on cyclosporin based immunosuppression. Furthermore, the complication rates were similar in those that received omeprazole and those that received ranitidine as antiulcer prophylaxis, indicating the equivalence of these two agents in this setting.

Lung Transplantation Exacerbates Gastroesophageal Reflux Disease *

“…GER has not been commonly found in other solid-organ transplant recipients, but only a few studies have carefully and systematically examined the nature and severity of GER in other transplant populations. 25 In particular, steroids, which are frequently used after transplantation, are known to worsen GER. Another factor that needs to be explored in future studies is the effect of the transplant operation on the diaphragm mechanics and the competence of the LES.…”

Relevance of GERD in Lung Transplant Patients

“…The relevance for increased GER of posttransplant medications (eg, steroids and cyclosporine) remains unknown. GER has not been found commonly in other solid-organ transplant recipients, but only a few studies have examined the nature and severity of GER in other transplant populations [37]. In particular steroids, which are frequently used after lung transplantation, could worsen GER.…”

Gastrointestinal Side Effects of Post-Transplant Therapy

“…It is clear [28] that patients treated especially with methyl-prednisolone during the crisis of rejection develop a greater rate of gastric and intestinal ulcerations, or of inflammatory lesions at this level in comparison with patients that do not undergo this type of treatment. What is also clear is that the development of peptic ulcers in transplanted patients is actually a multifactorial phenomenon.…”

“…In fact, many of the ulcerative lesions in transplanted patients are entirely asymptomatic. In one study, only 39% of patients who were proven to have endoscopic ulcerative lesions presented symptoms [28]. A fact that has not been fully clarified is that in lung transplant patients, especially in those with double lung transplant, giant gastric ulcers (larger than 3 cm) occur.…”

“…Such as, for example, the stress of the surgery, the use of non-steroidal anti-inflammatory drugs (NSAIDs), the use of steroids, the impairment of the existing mechanisms of GI cytoprotection by medications such as Aza or MMF, that slow the intestinal and gastric cell regeneration cycle [28], and the presence of infections. In the case of kidney transplantation there are other ulcer promoter factors such as increased gastric acid secretion during post-renal transplant dialysis, the effect of heparin used during dialysis, the increased histamine and gastrin levels during the post-surgical period [28].…”