Severe gastrointestinal complications after 1,515 adult kidney transplantations
Tóm tắt
We studied, retrospectively, the occurrence of severe gastrointestinal (GI) complications after kidney transplantation. After 1,515 consecutive adult kidney transplantations performed on 1,445 patients during 1990–1999 at our centre, 147 (10%) severe post-transplantation GI complications were found. Ten percent of the complications were fatal. The median follow-up time was 6.2 years. The main complications were gastroduodenal ulcers and colon complications. GI malignancy developed in 13 patients (0.9%). The complication rate for the first post-transplantation year was 4.8%. Delayed graft function, high age and polycystic kidney disease were risk factors. Five-year patient survival rate was significantly lower in patients with a first-year complication than in those with later or no GI complications (68% vs 88%). Graft survival with deaths censored was the same in both groups. In conclusion, severe GI complications during the first post-transplantation year remain a high risk factor also for long-term patient survival.
Tài liệu tham khảo
Andreoni K, Pelletier R, Elkhammas E, et al. Increased incidence of gastrointestinal surgical complications in renal transplant recipients with polycystic kidney disease. Transplantation 1999; 67:262–266.
Logan A, Morris-Stiff G, Bowrey D, Jurewicz W. Upper gastrointestinal complications after renal transplantation: a 3-yr sequential study. Clin Transplant 2002; 16:163–167.
Padilla B, Pallak V, Pesce A, Kant S, Gilinsky N, Deddens J. Pancreatitis in patients with end stage renal disease. Medicine 1994; 73:8–20.
Alberu J, Gatica M, Cachafeiro-Vilar M, et al. Asymptomatic gallstones and duration of cyclosporine use in kidney transplant recipients. Rev Invest Clin 2001; 53:396–400.
Fernandez-Cruz L, Targarona E, Cugat E, Alcaraz A, Oppenheimer F. Acute pancreatitis after renal transplantation. Br J Surg 1989; 76:1132–1135.
Frick T, Fryd D, Sutherland D, Goodale R, Simmons R, Najarian J. Hypercalcemia associated with pancreatitis and hyperamylasemia in renal transplant recipients. Am J Surg 1987; 154:487–489.
Mallory A, Kern F. Drug-induced pancreatitis: a critical review. Gastroenterology 1980; 78:813–818.
Kyllönen L, Salmela K, Pukkala E. Cancer incidence in a kidney-transplanted population. Transplant Int 2000; 13 [Suppl 1]:394–398.
Goodgame R. Gastrointestinal cytomegalovirus disease. Ann Intern Med 1993; 119:924–935.
Sarkio S, Rautelin H, Kyllönen L, Honkanen E, Salmela K, Halme L. Should Helicobacter pylori infection be treated before kidney transplantation? Nephrol Dial Transplant 2001; 16:2053–2057.
The T, van der Berg A, Harmsen M, van der Bij W, van Son W. The cytomegalovirus antigenemia assay; a plea for standardization. Scand J Infect Dis Suppl 1995; 99:25–29.
Kyllönen L, Salmela K, Eklund B, et al. Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection Transpl Int 2000; 13:122–128.
Bardaxoglou E, Maddern G, Ruso L, et al. Gastrointestinal surgical emergencies following kidney transplantation. Transpl Int 1993; 6:148–152.
Benoit G, Moukarzel M, Verdelli G, et al. Gastrointestinal complications in renal transplantation. Transpl Int 1993; 6:45–49.
Meyers W, Harris N, Stein S, et al. Alimentary tract complications after renal transplantation. Ann Surg 1978; 4:535–542.
Ahonen J, Eklund B, Lindfors O, Kuhlbäck B, Lindström B. Peptic ulceration in kidney transplantation. Proc Eur Dial Transplant Assoc 1977; 14:396–400.
Owens M, Passaro E, Wilson S, Gordon H. Treatment of peptic ulcer disease in renal transplant patients. Ann Surg 1977; 186:17–21.
Troppmann C, Paplois B, Chiou A, et al. Incidence, complications, treatment and outcome of ulcers of the upper gastrointestinal tract after renal transplantation during the cyclosporine era. J Am Coll Surg 1995; 180:433–443
Church J, Braun W, Norvick A, Fazio V, Steinmuller D. Perforation of the colon in renal homograft recipients Ann Surg 1986; 203:69–76.
Stelzner M, Vlahakos D, Milford E, Tilney N. Colonic perforations after renal transplantation. J Am Coll Surg 1997; 184:63–69.
Dominquez Fernandez E, Albrecht K, et al. Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease. Transpl Int 1998; 11:28–31.
Scheff R, Zuckerman G, Harter H, Delmez J, Koehler R. Diverticular disease in patients with chronic renal failure due to polycystic kidney disease. Ann Int Med 1980; 92:202–204.
The EBPG expert group on renal transplantation. European best practice guidelines for renal transplantation (part 1). Nephrol Dial Transplant 2000; 15 [Suppl 7]:6–7.
The EBPG expert group on renal transplantation. European best practice guidelines for renal transplantation (part 2). Nephrol Dial Transplant 2002; 17 [Suppl 4]:31–36.