Increased Prevalence of Gastrointestinal Symptoms Associated with Impaired Quality of Life in Renal Transplant Recipients

Ekberg, Henrik; Kyllönen, L.; Madsen, S.; Grave, Gisle; Solbu, D.; Holdaas, Hallvard

doi:10.1097/01.tp.0000251923.14697.f5

Cited by 77 publications

(85 citation statements)

References 52 publications

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“…iarrhea is a frequent complication in kidney transplant recipients (1)(2)(3)(4)(5)(6). Although diarrhea is often considered to be benign, severe episodes can cause dehydration with weight loss, high creatinine levels, and a fluctuation in serum immunosuppressive drug concentrations, resulting in a significant increase in mortality and morbidity and a poorer functional prognosis for the graft (1,2,6).…”

mentioning

confidence: 99%

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

Coste¹,

Vuiblet

Moustapha

et al. 2013

J Clin Microbiol

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Diarrhea is a frequent complication after kidney transplantation, ascribed to adverse effects of the immunosuppressive therapy in case of negative microbiological examination of the stools. The aim of this study was to improve the microbiological diagnosis by implementing molecular tests. Fifty-four severe diarrhea events that occurred in 49 adult kidney transplant recipients from September 2010 to November 2011 were investigated. One or several enteric pathogens were detected in 13 (23%) stool samples using classical microbiological methods versus 39 (72%) for the seven commercially available multiplex PCR assays used retrospectively (P ‫؍‬ 0.006). Interestingly, molecular diagnosis identified 15 multiple infections compared to none using classical techniques. The primary pathogens detected were enteropathogenic Escherichia coli (EPEC) (n ‫؍‬ 15; 38%), Campylobacter spp. (n ‫؍‬ 15; 38%), and Norovirus (n ‫؍‬ 14; 36%). Specificities for Campylobacter and Norovirus infection diagnosis were 75 and 100%, respectively, by comparison to reference methods. Based on molecular findings, a cyclosporine-mycophenolate mofetil combination was identified as a risk factor for developing Norovirus-induced diarrhea. Norovirus infections were also responsible for higher weight loss than all the other causes of diarrhea. In samples from asymptomatic immunocompromised and immunocompetent patients, EPEC but not Norovirus and Campylobacter infections were detected at a frequency similar to that observed in symptomatic kidney transplant recipients. In conclusion, molecular tools significantly improved the detection of single and multiple enteric infections by comparison to classical techniques and could quickly become the key element in the management of severe acute diarrhea in transplant recipients.

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mentioning

confidence: 99%

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

Coste¹,

Vuiblet

Moustapha

et al. 2013

J Clin Microbiol

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“…Many previous studies confirmed that GI symptoms are the most prevalent in the early period after kidney transplant and may adversely affect the quality of life of transplant recipients. 2 Despite this confirmation, it was demonstrated that GI symptoms are underdiagnosed by the doctors in the general population as well as in kidney transplant recipients. 20,21 In contrast to the early period after transplant, little is known about the patterns, causes, and consequences of GI symptoms in the longer term after kidney transplant in clinically and biochemically stable patients.…”

Section: Discussionmentioning

confidence: 99%

“…Tacrolimus has been associated with an increased risk of diarrhea (odds ratio of 1.7; 95% confidence interval, 1.4-2.0) and constipation (odds ratio of 1.3; 95% confidence interval, 1.1-1.6). 2,10 In contrast, another calcineurin inhibitor, cyclosporine, has been found to induce constipation in renal transplant recipients. 10 It has been demonstrated that patients who are treated with tacrolimus have more frequent occurrences of diarrhea, dyspepsia, and vomiting compared with patients treated with cyclosporine.…”

Section: Introductionmentioning

confidence: 99%

“…Immunosuppressive therapy is associated with a wide range of adverse effects, most often with the GI tract. [2][3][4] Although this relation has been well studied in patients early after kidney transplant, little is known so far about the risk factors, prevalence, pattern, and persistence of GI symptoms in patients in the long term after kidney transplant.…”

Section: Introductionmentioning

confidence: 99%

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Królikowski

Pawłowicz²,

Budzisz³

et al. 2016

Exp Clin Transplant

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Objectives: Although immunosuppressive drugs have been recognized as leading causes of gastrointestinal symptoms after kidney transplant, other widely used medications such as proton-pump inhibitors recently have been implicated. Our aim was to study the effects of chronic proton-pump inhibitor therapy on gastrointestinal symptoms in clinically stable patients late after kidney transplant. Materials and Methods:The study comprised 100 kidney transplant recipients (66 men and 34 women, mean age of 49 ± 12 y, mean time after transplant of 56 ± 46 mo). All patients completed the Gastrointestinal Symptoms Rating Scale and the Quality of Life Questionnaire SF-8 surveys. Results:The most commonly reported symptoms included borborygmus (27%), flatulence (23%), abdominal distension (18%), urgent need of defecation (17%), and heartburn, acid reflux, and eructation (13%). Proton-pump inhibitors were chronically used by 50% of patients and sporadically by 33%. Gastrointestinal Symptoms Rating Scale scores were higher in patients who used proton-pump inhibitors (mean score of 7.8 ± 5.5 vs 4.6 ± 3.0; P = .013). Total score of items representing diarrhea in the Gastrointestinal Symptoms Rating Scale (increased passage of stools, loose stools, urgent need of defecation, incomplete evacuation) was higher in patients treated with proton-pump inhibitors than in those not treated (2.3 ± 2.2 vs 1.3 ± 1.9; P = .04). Conclusions: Chronic use of proton-pump inhibitors may increase the prevalence of gastrointestinal symptoms, particularly diarrhea, in patients late after kidney transplant.

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“…The presence and severity of GI side effects, among transplant recipients, appear to be associated with lower quality of life [107]. These had often been underestimated by the treating clinicians as shown in a survey conducted by Ekberg et al [108,109]. Table 5 summarizes the discontinuation rate among patients treated with mTOR-I, together with the commonly encountered side effects.…”

Section: Safety Of Mtor-i Protocols In Kidney Transplantationmentioning

confidence: 99%

m-TOR Inhibitors in Kidney Transplantation: A Comprehensive Review

M¹,

Jm²,

Sharma³

et al. 2017

J Kidney

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Mammalian target of rapamaycin inhibitors (mTOR-I) has been in use in kidney transplantation for over two decades. Since their introduction, they have been used in different combination immunosuppressant for low risk group renal transplantation. They have been in use in the various (Calcineurin inhibitors) CNI-free protocols, either as De novo regiments, or by conversion from CNIs at a later stage. Many of these studies reported comparable graft rejection rate and a better kidney function (eGFR) compared to standard CNI protocols. Also mTOR-I when used in combination with CNIs, facilitated the use of lower doses of CNIs with the resultant reduction of CNI related side effects, without seriously compromising graft outcome. They are of particular interest among certain group of renal transplant recipients, including those with malignancy, post-transplant encapsulating peritoneal scelorosis, CMV and BK virus infections. Moreover, protocols containing mTOR-I showed comparable results to standard protocols among recipients of kidneys from extended-criteria transplantation. However, only few reports studied their use in high risk group renal transplantation, with variable outcomes. There is a noticeable drop in their popularity in the recent years, and their use was associated with multiple adverse events, in addition to a recent concern of their link to increased mortality. Also, a high discontinuation rate was demonstrated across many of the studies available to date. More studies are still needed to clarify the above-mentioned concerns.

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Increased Prevalence of Gastrointestinal Symptoms Associated with Impaired Quality of Life in Renal Transplant Recipients

Abstract: GI symptoms are associated with impaired HRQoL in the renal transplant population. Managing GI symptoms by careful choice of immunosuppressants should be a focus for improving HRQoL in renal transplant recipients.

Cited by 77 publications

References 52 publications

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

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m-TOR Inhibitors in Kidney Transplantation: A Comprehensive Review

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