Prevention of upper gastrointestinal complications after kidney transplantation

In 94 renal transplant patients, the incidence and mortality rate of upper gastrointestinal complications was lower than in 11 other reports comprising over three thousand patients. This difference may be due to the smaller doses of prednisolone used. Duodenal ulcer and erosive gastritis were the commonest lesions and 73% occurred in the first 6 months after operation. In 131 transplant candidates, gastric assessment including endoscopy showed 34 (26%) had peptic ulceration prior to operation. In 130 subjects (38 renal transplant, 68 chronic uraemia, 24 controls), pentagastrin tests showed acid hypersecretion in uraemic patients undergoing dialysis (P less than 0.02) and a tendency for acid output to decrease after operation (P less than 0.005). In 8 transplant patients with duodenal ulcer, preliminary experience with prophylactic cimetidine has been favorable. Upper gastrointestinal complications after renal transplantation are likely to be lessened by, a) use of less prednisolone in the early post-transplant phase; b) pre-transplant gastric assessment and c) the use of a safe and effective antisecretory drug in those with duodenal ulcer.