Related Experiment Video
Updated: May 1, 2026
Non-invasive Imaging of Acute Allograft Rejection after Rat Renal Transplantation Using 18F-FDG PET
Published on: April 28, 2013
Proton pump inhibitors do not increase the risk of acute rejection
G A J van Boekel1, C H H Kerkhofs, F van de Logt
1Department of Nephrology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Background:
Mycophenolate mofetil (MMF) is the prodrug of mycophenolic acid (MPA). Proton pump inhibitors impair exposure to MPA due to incomplete conversion from MMF. Lower exposure to MPA could result in an increased risk of acute rejection. We investigated whether MMF-treated renal transplant patients who concomitantly used pantoprazole as ulcer prophylaxis had a higher risk of acute rejection within the first three months after transplantation than those who used ranitidine.
Methods:
We performed a retrospective study in adult patients who underwent kidney transplantation between January 2007 and December 2011. Their immunosuppressive therapy consisted of steroids, tacrolimus and MMF and they used either pantoprazole or ranitidine as ulcer prophylaxis.
Results:
202 patients were included: 125 using pantoprazole and 77 using ranitidine. There was no difference in the number of patients with biopsy-proven acute rejection (BPAR): 13 (10.4%) in the pantoprazole group versus 7 (9.1%) in the ranitidine group (NS). Also after correction for inequalities between the two groups, there was no significant relationship between the risk of BPAR and the type of anti-ulcer agent.
Conclusion:
There was no evidence for an increased incidence of BPAR in renal transplant patients who use pantoprazole in combination with MMF.
Insights
Proton pump inhibitors like pantoprazole do not increase the risk of acute rejection in kidney transplant patients treated with mycophenolate mofetil (MMF). Ranitidine use showed similar outcomes for acute rejection rates in MMF-treated patients.
Area of Science:
- Nephrology
- Pharmacology
- Transplantation Medicine
Background:
- Mycophenolate mofetil (MMF) is a key immunosuppressant for renal transplant recipients.
- Proton pump inhibitors (PPIs) may reduce exposure to mycophenolic acid (MPA), the active metabolite of MMF.
- Reduced MPA exposure is a potential risk factor for acute rejection post-transplant.
Purpose of the Study:
- To evaluate if concomitant use of pantoprazole with MMF increases acute rejection risk in renal transplant patients.
- To compare acute rejection rates between patients using pantoprazole versus ranitidine for ulcer prophylaxis.
Main Methods:
- Retrospective study of adult renal transplant patients (2007-2011).
- Patients received immunosuppression including steroids, tacrolimus, and MMF.
- Ulcer prophylaxis was managed with either pantoprazole or ranitidine.
Main Results:
- 202 patients were analyzed (125 pantoprazole, 77 ranitidine).
- No significant difference in biopsy-proven acute rejection (BPAR) rates: 10.4% (pantoprazole) vs. 9.1% (ranitidine).
- Statistical analysis confirmed no significant relationship between anti-ulcer agent and BPAR risk.
Conclusions:
- Pantoprazole use in combination with MMF does not elevate the incidence of acute rejection in renal transplant recipients.
- The choice of anti-ulcer agent (pantoprazole vs. ranitidine) did not impact BPAR risk.
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