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

Background: Upper gastrointestinal complications have historically resulted in considerable morbidity and mortality to renal transplant recipients. Over the last decade, antiulcer prophylaxis with proton‐pump inhibitors and immunosuppression with tacrolimus‐based regimes have been introduced. Little has been written about foregut complications after renal transplantation since the use of these agents. The aim of this study was to compare the frequency of upper gastrointestinal complications after renal transplantation in patients treated with (i) omeprazole vs. ranitidine, and (ii) tacrolimus vs. cyclosporin based immunosuppression. Methods: Information on 236 patients undergoing renal transplantation between January 1996 and December 1998 was collected prospectively onto a computerized database. Results: Overall, 20 patients (8%) developed upper gastrointestinal complications, opportunistic infections accounted for 9/20 (45%). No patient developed gastroduodenal ulceration, required laparotomy, suffered graft loss or died. There was no significant difference in the frequency of complications between patients that received antisecretory therapy with omeprazole (9/118, 8%) and those that received ranitidine (11/118, 9%), nor between those that were on tacrolimus (7/101, 7%) and those on cyclosporin (13/135, 10%) based immunosuppression regimes. Patients that developed foregut complications were significantly older than those not developing complications (mean age 50 vs. 43 yrs, p=0.05). Further, patients that developed opportunistic infections were more frequently diabetic than those in whom opportunistic infections were not seen (4/31, 13% vs. 5/205, 2%), p=0.02. Conclusions: 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.