Gastroparesis following kidney/pancreas transplant

Abstract

This pilot study examined associations among patterns of gastric myoelectrical activity, symptoms of gastroparesis, years of diabetes, months of dialysis, and use of gastrointestinal medications in gastroparetic kidney-pancreas (KP) transplant recipients. Electrogastrography (EGG) and gastric symptom data were obtained from 42 transplant recipients before and after transplant (6, 12, and 24 months). Recipients were 38 +/- 7 yr of age, 88% Whites, and 60% male; 97% had hypertension. All had functioning grafts post-transplant (mean creatinine, 1.59 +/- 0.66 mg/dL, and serum glucose 91.97 +/- 24.92 mg/dL). Sixteen subjects had normal EGG (2.7-3.2 cycles per minute, cpm); two were tachygastric (>3.2 cpm) at all time points; one remained bradygastric (<2.7 cpm) throughout the study period. Following transplant, symptoms lessened and were associated with 6-month normalization of EGG (r = 0.41, p = 0.02). A small change in the percentage of patients with normal EGG was observed from baseline to 24 months (67% vs. 69% respectively); however, there was a shift from bradygastria (29% to 15% respectively) to tachygastria (5% to 15% respectively). Prescribed prokinetic and antisecretory medications use increased over the study period from 13 (31%) subjects at baseline to 32 (86%) at 6 months; 21 (78%) at 12 months; and 12 (92%) at 24 months. Although symptoms diminish following transplant, gastroparesis remains a significant problem for transplant patients. Normalization of EGG and shifts from bradygastria to tachygastria occur post-transplant. Our results suggest that serial EGGs and frequent assessment of symptoms can be used to follow gastroparesis in KP recipients.

Type 1 diabetes and gastroparesis: Diagnosis and treatment

“…Pancreas transplants prevent progression of such preexisting diabetic complications as neuropathy or retinopathy, but evidence on the benefits of this intervention in diabetic gastroparesis is conflicting. Investigators in one report concluded that, although symptoms may decrease after pancreas/kidney transplant, gastroparesis remains a challenging problem [47].…”

Management of gastroparesis

“…Unfortunately, extraintestinal complications developed in three patients, two of whom died; thus, the benefits of the procedure were not clearly demonstrated. Likewise, studies report conflicting data on the benefits of pancreatic transplantation in patients with diabetic gastroparesis [94].…”

Diabetic gastroparesis: Therapeutic options

“…Jejunostomies are indicated to maintain fluid balance and nutritional status,92 and can be an effective “last resort” measure 92. Interestingly, pancreatic transplantation has been shown to benefit those with DG 94. Studies assessing neuropathy have shown early nerve fiber regeneration in type 1 diabetic patients after pancreas transplantation,95 and this may be the potential basis for relieving symptoms, but of course, overall improved glycemic control must play a role in improving gastric emptying.…”