Upper gastrointestinal complications after renal transplantation: a 3-yr sequential study
Upper gastrointestinal complications after renal transplantation: a 3-yr sequential study
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DOI：
10.1034/j.1399-0012.2002.01012.x
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发表时间：
2002-06-01
影响因子：
2.1
通讯作者：
Jurewicz, WA
中科院分区：
文献类型：
--
作者：
Logan, AJ;Morris-Stiff, GJ;Jurewicz, WA
背景：上消化道并发症历史上曾导致肾移植受者相当高的发病率和死亡率。在过去的十年中，已经引入了质子泵抑制剂的抗溃疡预防和以他克莫司为基础的免疫抑制。自从使用这些药物以来，很少有关于肾移植后前庭并发症的报道。本研究旨在比较(I)奥美拉唑与雷尼替丁、(Ii)他克莫司与环孢素类免疫抑制剂治疗肾移植术后上消化道并发症的发生率。方法：前瞻性收集1996年1月至1998年12月间肾移植患者236例的资料。结果：20例(8%)患者发生上消化道并发症，机会性感染占9/20(45%)。无一例患者发生胃十二指肠溃疡，需要剖腹手术，无移植物丢失或死亡。接受奥美拉唑抗分泌治疗的患者(9/118，8%)与接受雷尼替丁治疗的患者(11/118，9%)、服用他克莫司的患者(7/101，7%)和服用环孢素的患者(13/135，10%)之间的并发症发生率无显著差异。出现前肠并发症的患者显著高于未发生并发症的患者(平均年龄50岁对43岁，p=0.05)。此外，发生机会性感染的患者比未发生机会性感染的患者糖尿病发生率更高(4/31，13%比5/205，2%)，p=0.02。结论：我们观察到肾移植术后上消化道并发症的发生率较低(8%)。服用他克莫司的患者和服用环孢素类免疫抑制剂的患者之间的并发症发生率没有差异。此外，在接受奥美拉唑和雷尼替丁作为抗溃疡预防药物的患者中，并发症发生率相似，这表明这两种药物在这一设置中是对等的。
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.