Gastroenterological complications in kidney transplant patients

Calogero, Armando; Gallo, Monica; Sica, Antonello; Peluso, G.; Scotti, Alessandro; Tammaro, Vincenzo; Carrano, Rosa; Federico, Stefano; Lionetti, Ruggero; Amato, Maurizio; Carlomagno, Nicola; Dodaro, Concetta Anna; Sagnelli, Caterina; Santangelo, Michele

doi:10.1515/med-2020-0130

Cited by 10 publications

(11 citation statements)

References 80 publications

(87 reference statements)

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“…The RNA‐1273 vaccine is a mRNA vaccine composed in part by the S protein genetic code embedded in lipid nanoparticles (http://ClinicalTrials.gov: NCT04283461) 89 currently evaluated in a clinical trial on 45 healthy individuals aged 18 to 55 years. Other mRNA‐based vaccines have been developed and are currently in various stages of development 90 . INO‐4800 is a DNA‐based vaccine using the Spike gene that has already entered phase I clinical trials and involves intradermal inoculation by electroporation.…”

Section: Natural Body's Defense Mechanisms and Treatment Attemptsmentioning

confidence: 99%

The impact of the SARS‐CoV‐2 infection, with special reference to the hematological setting

Sica

Casale

Rossi

et al. 2020

Journal of Medical Virology

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a disease known from a few months, caused by a recently arisen virus and, consequently, it is little known. The disease has a benign course in most infected subjects (children and young adults), is often symptomatic in adults over the age of 50 and often serious and life threatening in people with comorbidities and the elderly. The few data published on coronavirus disease-2019 (COVID-19) in the blood-oncology field report a serious clinical presentation, a serious course of the disease, and a high mortality rate, as has also been reported for other cancer contexts. The current strategy for treating patients with SARS-CoV-2 includes antivirals that are effective against other viral infections and drugs that can moderate the cytokine storm. There is no specific vaccine and consequently all possible precautions must be taken to prevent SARS-CoV-2 infection in the areas of oncology, oncohematology, and bone marrow transplantation. In this reviewer's article, we report the information currently available on SARS-CoV-2 infection to help young doctors and hematologists to successfully manage patients with COVID-19.

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Section: Natural Body's Defense Mechanisms and Treatment Attemptsmentioning

confidence: 99%

The impact of the SARS‐CoV‐2 infection, with special reference to the hematological setting

Sica

Casale

Rossi

et al. 2020

Journal of Medical Virology

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“…Infection, drug interaction, and direct effect on the GI mucosa have been implied by previous studies. 24 , 110 Moreover, the macrolide structure of TAC mimicking the action of motilin may partly explain the higher incidence of diarrhea. 16 , 111 …”

Section: Calcineurin Inhibitorsmentioning

confidence: 99%

Gastrointestinal injury induced by immunomodulators: A review article

Zhang

Mao

Zhang

et al. 2023

Therap Adv Gastroenterol

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An increasing number of immunomodulators, either anti-inflammatory or immunity-enhancing, have brought about a revolutionary effect in the management of a variety of autoimmune disorders and malignancies. However, their ability to cause gastrointestinal (GI) injury and induce GI symptoms has been increasingly and unexpectedly recognized. GI injury associated with immunomodulators may demonstrate various histologic and endoscopic patterns. Optimal diagnosis and treatment require a multidisciplinary approach. This review aims to provide an overview of the literature on its pathogenesis, the clinical, endoscopic, and histologic features, and suggested approaches to manage these newly recognized immunomodulator-induced GI adverse effects (AEs). We also reviewed current biomarkers predictive of GI toxicity and potential risk factors to identify susceptible patients. In addition, these immune-mediated AEs were compared with inflammatory bowel disease, a well-documented form of inflammation-driven GI injury. We hope this review will raise awareness and vigilance among clinicians of these entities to increase early diagnosis and rapid referral to specialist care.

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“…However, we identified fifteen cases with discordant blood and tissue CMV replication assays, in which tissue sample analysis was necessary to make a diagnosis. 28,29,32,42,45,51,54,60,[69][70][71]73 When KTRs present with GI signs and symptoms and hCVM is not detectable in blood, cross-sectional imaging, such as abdomen CT or MRI, has a role, 104 but, more significantly, endoscopy with tissue sampling might speed diagnosis and targeted treatment start, 75,105 especially in KTRs with recent episodes of GI bleeding. The major advantages of endoscopy are the possibility to obtain tissue specimens, and to promptly treat active sources of bleeding.…”

Section: Patientsmentioning

confidence: 99%

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

Zais,

Sirotti,

Iesari

et al. 2023

Clinical Transplantation

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BackgroundHuman‐cytomegalovirus (hCMV) infection involving the gastrointestinal tract represents a leading cause of morbidity and mortality among kidney transplant (KT) recipients (KTRs). Signs and symptoms of the disease are extremely variable. Prompt anti‐viral therapy administration and immunosuppression modification are key factors for optimizing management. However, complex work‐up strategies are generally required to confirm the preliminary diagnosis. Unfortunately, solid evidence and guidelines on this specific topic are not available.We consequently aimed to summarize current knowledge on post‐KT hCMV‐related gastrointestinal disease (hCMV‐GID).MethodsWe conducted a systematic review (PROSPERO ID: CRD42023399363) about hCMV‐GID in KTRs.ResultsOur systematic review includes 52 case‐reports and ten case‐series, published between 1985 and 2022, collectively reporting 311 cases. The most frequently reported signs and symptoms of hCMV‐GID were abdominal pain, diarrhea, epigastric pain, vomiting, fever, and GI bleeding. Esophagogastroduodenoscopy and colonoscopy were the primary diagnostic techniques. In most cases, the preliminary diagnosis was confirmed by histology. Information on anti‐viral prophylaxis were extremely limited as much as data on induction or maintenance immunosuppression. Treatment included ganciclovir and/or valganciclovir administration. Immunosuppression modification mainly consisted of mycophenolate mofetil or calcineurin inhibitor minimization and withdrawal. In total, 21 deaths were recorded. Renal allograft‐related outcomes were described for 26 patients only. Specifically, reported events were acute kidney injury (n = 17), transplant failure (n = 5), allograft rejection (n = 4), and irreversible allograft dysfunction (n = 3).ConclusionsThe development of local and national registries is strongly recommended to improve our understanding of hCMV‐GID. Future clinical guidelines should consider the implementation of dedicated diagnostic and treatment strategies.

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Gastroenterological complications in kidney transplant patients

Cited by 10 publications

References 80 publications

The impact of the SARS‐CoV‐2 infection, with special reference to the hematological setting

The impact of the SARS‐CoV‐2 infection, with special reference to the hematological setting

Gastrointestinal injury induced by immunomodulators: A review article

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

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