Gastrointestinal complications after kidney transplantation

Abstract

Gastrointestinal complications are common after renal transplantation, and they have a wide clinical spectrum, varying from diarrhoea to post-transplant inflammatory bowel disease (IBD). Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. Drug-related colitis are the most frequently encountered colitis after kidney transplantation, particularly those related to the chronic use of mycophenolate mofetil, while de novo IBDs are quite rare. This review will explore colitis after kidney transplantation, with a particular focus on different clinical and histological features, attempting to clearly identify the right treatment, thereby improving the final outcome of patients.

Protocol for a pilot single-centre, parallel-arm, randomised controlled trial of dietary inulin to improve gut health in solid organ transplantation: the DIGEST study

“…42 43 47 48 Together with inulin's wide availability and low cost, it forms an ideal investigational supplement for use in the posttransplant period. However, with gastrointestinal adverse events common in KTRs, 49 the adherence and tolerability of inulin supplementation in this cohort remains unknown and requires investigation.…”

De novo ulcerative colitis after kidney transplantation treated with infliximab

“…Table 1 showed the endoscopic and histopathological characteristics of above differential diagnosis. The definitive diagnosis of CMV-colitis requires formalin-fixed tissue with immunochemistry and tissue polymerase chain reaction (PCR) [8]. MMF-related colitis is suspected by endoscopic and histological features shown in Table 1, and confirmed when improved only by discontinuation of MMF or a 50% reduction in the initial dose of MMF [8].…”

“…The definitive diagnosis of CMV-colitis requires formalin-fixed tissue with immunochemistry and tissue polymerase chain reaction (PCR) [8]. MMF-related colitis is suspected by endoscopic and histological features shown in Table 1, and confirmed when improved only by discontinuation of MMF or a 50% reduction in the initial dose of MMF [8]. It seems essential to judge comprehensively for post-KT diarrhea by clinical symptoms, endoscopic findings, histopathological examination and therapeutic diagnosis.…”

“…Histological findings MMF related colitis [5,8] Erosions, hyperemia, erythema, Eosinophils and plasma cells infiltrate, withered crypts, apoptotic bodies CMV infection [8] Patchy erythema, exudates, microerosions Enterocyte apoptosis, inclusion bodies de novo UC [4,16] Erythema, loss of normal vascular pattern, granularity, erosions, friability, bleeding, and ulcerations [14]. Nonetheless, several complications were observed.…”

Colorectal Cancer after Kidney Transplantation: A Screening Colonoscopy Case-Control Study

“…The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines for the care of kidney transplant recipients suggested screening from the age of 50 years with annual faecal haemoglobin and flexible sigmoidoscopy screening every 5 years in all renal transplant recipients [9][10][11][12]20,21] and that this might be cost effective [22,23]. However, there are limited data on the prevalence of advanced colorectal neoplasia in kidney transplant recipients [9,10], and screening might be limited by the low efficacy of FOBT due to the expected increase of false-positives due to the toxicity of immunosuppression, cytomegalovirus infection, and minor mucosal inflammation [24][25][26].…”