Renal allograft survival requires multiple immunosuppressive drugs. This strategy may lead to gastric complications that necessitate gastro‐protective medications, notably, proton pump inhibitors (PPI). This study aimed to compare the influence of pantoprazole and esomeprazole on serum cyclosporine trough levels (C0) in renal transplant recipients (RTR). A prospective, parallel, open‐label trial was conducted on 47 adult RTR receiving cyclosporine doses adjusted to attain trough concentrations of 100 to 150 μg/L, mycophenolate mofetil (MMF) 750 mg q12 hour and prednisolone at 5 mg daily at Nasser Institute, Cairo, Egypt from January to September 2016. Patients were randomized into the esomeprazole group (25) or pantoprazole group (22) receiving the same dose (40 mg once daily). The study outcomes included clinical signs of rejection and renal function decline, assessed by elevations in serum creatinine, caused by cyclosporine level variations in either of the two study groups. Renal function, C0 and CBC measurements were measured at baseline and monthly for 6 months. The mean C0 values were higher in the pantoprazole group than in the esomeprazole group in the sixth month only (P = .007). Serum creatinine level was lower in the sixth month than at baseline in the esomeprazole group (P = .004). There were no signs of rejection biochemical or clinical in any of the study groups. In conclusion, PPIs should be used with caution and doses should be titrated to reach the C0 targets in RTR, which is of more importance in pantoprazole than esomeprazole to avoid C0 level elevation or decline affecting the allograft function.

Renal allograft survival requires the administration of multiple immunosuppressive drugs. This strategy may lead to gastric complications that necessitate gastro-protective medications, notably, proton pump inhibitors (PPIs). This study aimed to compare the effects of pantoprazole and esomeprazole on renal function in stable renal transplant recipients. A prospective, parallel, open-label clinical trial was performed with forty-seven adult renal transplant recipients receiving immunosuppressive therapy with cyclosporine (CSA) doses adjusted to attain trough concentrations of 100-150 μg/L, mycophenolate mofetil (MMF) at 750 mg q12 h and prednisolone at 5 mg daily at Nasser Institute, Cairo, Egypt. The enrolled participants were randomized into two groups, which received either esomeprazole or pantoprazole at the same dose (40 mg once daily). Renal function was measured at baseline and monthly for 6 months. The study was conducted between January-September 2016. Main outcome measures clinical signs of rejection reflected by renal function decline, assessed by elevated levels of serum creatinine. The mean serum creatinine level was significantly lower in the sixth month than at baseline in esomeprazole group (p 0.004); interestingly there was a continuous decrease of serum creatinine levels in esomeprazole group and nearly constant values in pantoprazole group. There was no significant difference in serum creatinine levels between the two groups. From this study, it could be concluded that esomeprazole may be preferred over pantoprazole in renal transplant recipients because it decreased serum creatinine which is one of the markers of chronic allograft rejection in stable renal transplantation recipients.