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Published on: April 12, 2021
Gastrointestinal disorders after renal transplantation
E Savvidaki1, E Papachristou1, P Kazakopoulos1
1University Hospital of Patras, Transplantation Center, Patras, Greece.
Background:
Gastrointestinal disorders (GDs) are common in renal transplant recipients. The main cause of GDs seems to be the use of immunosuppressive medications, especially mycophenolic acid in the form of mycophenolate mofetil (MMF).
Objective:
The aim of this study was to estimate the frequency and severity of GDs in renal allograft recipients with the use of the Gastrointestinal Symptom Rating Scale (GSRS).
Methods:
Eighty-five renal allograft recipients, 50 ± 12 years old, treated with methylprednisolone, calcineurin inhibitor (cyclosporine [CsA], n = 42; tacrolimus (TAC), n = 43), and MMF were studied.
Results:
At the time of completion of the GSRS questionnaire, 38 of the 85 patients (45%) already had their MMF dose reduced because of GDs. Only 15 patients (18%) were totally free from GDs. The most frequent and severe GDs recorded were indigestion and diarrhea who were significantly more frequent in women (P = .045). GDs were recorded in patients receiving both standard and reduced dose of MMF. MMF dose was significantly associated only with diarrhea. Although TAC-treated patients had the highest mean GSRS scores, no statistically significant differences were observed compared with CsA-treated patients. In 31 patients, MMF was replaced by enteric-coated mycophenolate sodium (EC-MPS) and new questionnaires were completed 1 month later. Significant improvement in total and all subscores of GSRS was demonstrated (P < .001). Although EC-MPS dose tolerated by the patients was higher than MMF dose, the difference was not statistically significant.
Conclusions:
Female sex and the use of MMF, especially in combination with TAC, are related to the occurrence of severe gastrointestinal symptoms. Substitution of MMF with EC-MPS significantly reduces the severity of symptoms and permits the use of higher doses.
Insights
Gastrointestinal disorders (GDs) are common in renal transplant patients using mycophenolate mofetil (MMF). Switching to enteric-coated mycophenolate sodium (EC-MPS) significantly improved symptoms, especially in women and those on tacrolimus (TAC).
Area of Science:
- Nephrology
- Gastroenterology
- Pharmacology
Background:
- Gastrointestinal disorders (GDs) are prevalent in renal transplant recipients.
- Immunosuppressants, particularly mycophenolate mofetil (MMF), are a primary cause of GDs.
Purpose of the Study:
- To assess the frequency and severity of GDs in renal allograft recipients using the Gastrointestinal Symptom Rating Scale (GSRS).
- To evaluate the impact of switching from MMF to enteric-coated mycophenolate sodium (EC-MPS) on GDs.
Main Methods:
- Eighty-five renal allograft recipients treated with MMF were assessed using the GSRS.
- MMF dosage adjustments and patient sex were recorded.
- A subset of 31 patients switched to EC-MPS, with subsequent GSRS re-evaluation.
Main Results:
- 45% of patients had MMF dose reductions due to GDs; only 18% were symptom-free.
- Indigestion and diarrhea were the most frequent and severe GDs, more common in women.
- Switching to EC-MPS led to significant improvements in GSRS scores (P < .001).
Conclusions:
- Female sex and MMF use, especially with tacrolimus (TAC), correlate with severe gastrointestinal symptoms.
- Replacing MMF with EC-MPS effectively reduces GD severity and allows for higher tolerated doses.
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