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Upper gastrointestinal bleeding during the first month after renal transplantation in the mycophenolate mofetil era
M R Ardalan1, J Etemadi, M H Somi
1Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, Iran. ardalan34@yahoo.com
Abstract:
Upper gastrointestinal (GI) bleeding remains a significant cause of mortality and morbidity among renal transplant recipients. We retrospectively analyzed the records of patients who received renal transplantations between January 2001 and July 2007 using mycophenolate mofetil (MMF) in their immunosuppressive regimens. The following data were recorded for those subjects with upper GI bleeding during the first month after transplantation (group B, cases): age, sex, acute rejection episodes, pretransplant upper GI endoscopic findings, Helicobacter positivity, and cytomegalovirus (CMV) seropositivity. The same parameters were studied among a group of patients, who did not have a history of upper GI bleeding (group A, controls). A statistical analysis was performed to ascertain potential risk factors. Among 523 patients (311 females, 212 males) of age range 7 to 58 years, 27 (5.2%) had upper GI bleeding: 13 males and 14 females of mean age 44 +/- 12 years. The most frequent endoscopic finding was erosive gastritis (n = 13; 48.1%) followed by duodenal ulcers. Binary logistic regression analysis comparing the 2 groups showed that acute rejection episodes (P = .015) and active CMV infection (P = .046) were the most prominent risk factors for upper GI bleeding during the first month after renal transplantation.
Insights
Upper gastrointestinal bleeding is a risk for renal transplant patients. Acute rejection and active cytomegalovirus infection are key risk factors within the first month post-transplant.
Area of Science:
- Nephrology
- Gastroenterology
- Transplant Surgery
Background:
- Upper gastrointestinal (GI) bleeding is a serious complication in renal transplant recipients.
- Mycophenolate mofetil (MMF) is commonly used in immunosuppressive regimens for these patients.
Purpose of the Study:
- To identify risk factors for upper GI bleeding in the first month after renal transplantation.
- To analyze the association between immunosuppression, rejection, and GI bleeding.
Main Methods:
- Retrospective analysis of 523 renal transplant recipients between January 2001 and July 2007.
- Comparison of patients with (cases) and without (controls) upper GI bleeding within the first month post-transplant.
- Statistical analysis including binary logistic regression to identify risk factors.
Main Results:
- 5.2% of patients experienced upper GI bleeding within the first month.
- Erosive gastritis was the most common endoscopic finding (48.1%).
- Acute rejection episodes (P = .015) and active cytomegalovirus (CMV) infection (P = .046) were significant risk factors.
Conclusions:
- Acute rejection and active CMV infection are prominent risk factors for early upper GI bleeding after renal transplantation.
- These findings highlight the need for vigilant monitoring for GI complications in renal transplant recipients, particularly those experiencing rejection or CMV infection.
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