Skip to main content

Advertisement

SpringerLink
Log in

Gastrointestinal complications in renal transplant recipients detected by endoscopic biopsies in a developing country

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Renal transplantation is the treatment of choice for patients with end-stage renal disease. The renal transplant recipients are susceptible to a variety of gastrointestinal (GI) complications such as infections, ulcer disease, and malignancies.

Objectives

We aimed to determine the frequency of pathological lesions in GI endoscopic biopsies in recipients of live related renal transplantation in our setting.

Methods

This retrospective survey was carried out at Histopathology Department of Sindh Institute of Urology and Transplantation, Karachi, from December 2010 to January 2011. All consecutive renal transplant patients of all ages and both genders on regular follow up, presenting with GI complaints and in whom GI endoscopic biopsies were performed, were included. The demographic, clinical, and laboratory data were retrieved from case files and the pathological diagnoses from the original biopsy reports.

Results

A total of 200 consecutive renal transplant patients were enrolled. The biopsies comprised of 19 (9.5 %) esophageal biopsies, 119 (59.5 %) gastric biopsies, 148 (74 %) duodenal biopsies, and 66 (33 %) colorectal biopsies. The main pathological lesions included cytomegalovirus infection in 22 (11 %) of all patients, Helicobacter pylori in 11 (9.2 %) of gastric biopsies, cryptosporidium in 4 (1.6 %), giardiasis in 30 (15 %), immunoproliferative small intestinal disease in 5 (3.4 %), tropical sprue in 33 (15 %), tuberculosis in 3 (2 %) of the small intestinal biopsies, and gastric adenocarcinoma in 1 (1.7 %) gastric biopsy.

Conclusion

A wide spectrum of pathological lesions including opportunistic infections was seen in GI endoscopic biopsies in renal transplant patients. Endoscopic biopsies play an important role in the diagnosis and management of GI disease in renal transplant patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abbas K, Muzzafar R, Zafar M, Mubarak M, Naqvi S, Rizvi S. Evaluation of pre-transplant T-cell activation status by soluble CD30 determination. J Pak Med Assoc. 2009;59:212–5.

    PubMed  Google Scholar 

  2. Cecka JM, Terasaki PI. The UNOS scientific renal transplant registry. United Network for Organ Sharing. Clin Transpl 1995;1─18.

  3. Ponticelli C, Passerini P. Gastrointestinal complications in renal transplant recipients. Transpl Int. 2005;18:643–50.

    Article  PubMed  Google Scholar 

  4. Abbas Z, Hassan S, Naqvi S, Rizvi S. Weight loss in renal transplant recipients. J Nephrol Urol Transplant. 2002;3:11–3.

    Google Scholar 

  5. Sarkio S, Halme L, Kyllonen L, Salmela K. Severe gastrointestinal complications after 1,515 adult kidney transplantation. Transpl Int. 2004;17:505–10.

    Article  PubMed  Google Scholar 

  6. Pahl M, Vaziri N, Martin D. Pathology of digestive organs in renal transplant recipients. J Natl Med Assoc. 1986;78:721–6.

    PubMed Central  CAS  PubMed  Google Scholar 

  7. Archibald S, Jirsch D, Bear R. Gastrointestinal complications of renal transplantation. Can Med Assoc J. 1978;119:1291–6.

    PubMed Central  CAS  PubMed  Google Scholar 

  8. Stelzner M, Vlahakos D, Milford E, Tilney N. Colonic perforations after renal transplantation. J Am Coll Surg. 1997;184:63–9.

    CAS  PubMed  Google Scholar 

  9. Helderman J, Goral S. Gastrointestinal complications of transplant immunosuppression. J Am Nephrol. 2002;13:277–87.

    Google Scholar 

  10. Tappeh K, Gharavi M, Makhdoumi K, Rahbar M, Taghizadeh A. Prevalence of Cryptosporidium ssp. infection in renal transplant and hemodialysis patients. Iran J Publ Health. 2006;3:54–7.

    Google Scholar 

  11. Rostami M, Keshavarz H, Eskandari E, Kia E, Rezaeian M. Intestinal parasites in renal transplant recipients. Iran J Parasitol. 2007;3:16–23.

    Google Scholar 

  12. Kälbe T, Lucan M, Nicita G, et al. EAU guidelines on renal transplantation. Eur Urol. 2005;47:156–66.

    Article  Google Scholar 

  13. Knoll G, Cocfield S, Blydt-Hansen T, et al. Canadian society of transplantation: consensus guidelines on eligibility for kidney transplantation. Can Med Assoc J. 2005;173:1–25.

    Article  Google Scholar 

  14. Hardinger K, Brennan D, Lowell J, Schnitzler M. Long-term outcome of gastrointestinal complications in renal transplant patients treated with mycophenolate mophetil. Transpl Int. 2004;17:609–16.

    Article  PubMed  Google Scholar 

  15. Fishman J, Rubin R. Infection in organ-transplant recipients. N Engl J Med. 1998;338:1741–51.

    Article  CAS  PubMed  Google Scholar 

  16. Shrestra B, Parton D, Gray A, et al. Cytomegalovirus involving gastrointestinal tract in renal transplant recipients. Clin Transplant. 1996;10:170–5.

    Google Scholar 

  17. Meng G, Smith P. Gastrointestinal infections of the immunocompromised host. Curr Opin Gastroenterol. 1999;15:85–9.

    Article  CAS  PubMed  Google Scholar 

  18. Lautenschlager I. Cytomegalovirus and solid organ transplantation: an update. Curr Opin Organ Transplant. 2003;8:271–7.

    Article  Google Scholar 

  19. Graham S, Flowers J, Schweizer E, Bartlett S, Imbembo A. Opportunistic upper gastrointestinal infection in transplant recipients. Surg Endosc. 1995;9:146–50.

    Article  CAS  PubMed  Google Scholar 

  20. Schiller LR, Pardi DS, Spiller R, et al. Gastro 2013 APDW/WCOG Shanghai working party report: chronic diarrhea: definition, classification, diagnosis. J Gastroenterol Hepatol. 2014;29:6–25.

    Article  PubMed  Google Scholar 

  21. Ahonen J, Eklund B, Lindfors O, Kuhlbäck B, Lindström B. Peptic ulceration in kidney transplantation. Proc Eur Dial Transplant Assoc. 1977;14:396–400.

    CAS  PubMed  Google Scholar 

  22. Benoit G, Moukarzel M, Verdelli G, et al. Gastrointestinal complications in renal transplantation. Transplant Int. 1993;6:45–9.

    Article  CAS  Google Scholar 

  23. Meyers WC, Harris N, Stein S, et al. Alimentary tract complications after renal transplantation. Ann Surg. 1979;190:535–42.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Kathuria P, Sakhuja V, Gupta KL, et al. Gastrointestinal complications after renal transplantation. ASAIOJ. 1995;41:M698–703.

    Article  CAS  Google Scholar 

  25. Özgur O, Boyacioglu S, Özdogan M, Gur G, Telatar H, Haberal M. Helicobacter pylori infection in haemodialysis patients and renal transplant recipients. Nephrol Dial Transplant. 1997;12:289–91.

    Article  PubMed  Google Scholar 

  26. Lichtenstein IH, Macgregor RR. Mycobacterial infections in renal transplant patients. Report of 5 cases and review of the literature. Rev Infect Dis. 1983;5:216–26.

    Article  CAS  PubMed  Google Scholar 

  27. Malhotra KK, Dash SC, Dhawan IK, Bhuyan UN, Gupta A. Tuberculosis and renal transplantation-observation from an endemic area of tuberculosis. Postgrad Med J. 1986;62:359–62.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Naqvi SA, Hussain M, Askari H, et al. Is there a place for prophylaxis against tuberculosis following renal transplantation? Transplant Proc. 1992;24:1912.

    CAS  PubMed  Google Scholar 

  29. Mosimann F, Cuénoud PF, Steinhäuslin F, Wauters JP. Herpes simplex esophagitis after renal transplantation. Transplant Int. 1994;7:79–82.

    Article  CAS  Google Scholar 

  30. Rosekrans P. Gastrointestinal complications after renal transplantation. Radiol Clin. 1975;47:32–43.

    Google Scholar 

  31. Peter A, Telkes G, Varga M, Sarvary E, Kovalszky I. Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single experience. Clin Transplant. 2004;18:580–4.

    Article  PubMed  Google Scholar 

  32. Feng S, Buell J, Chari R, Di Maio J, Hanto D. Tumours and transplantation: The 2003 third annual ASTS state of the art winter symposium. Am J Transplant. 2003;3:1481–7.

    Article  PubMed  Google Scholar 

  33. Kyllönen L, Salmela K, Pukkala E. Cancer incidence in a kidney-transplanted population. Transpl Int. 2000;13 Suppl 1:394–8.

    Article  Google Scholar 

  34. Aull M, Buell J, Peddi V, et al. A Helicobacter pylori-associated malignancy in transplant patients. Transplantation. 2003;27:225–8.

    Article  Google Scholar 

Download references

Conflict of interest

MI, RR, and MM declare that they have no conflict of interest.

Ethical statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning Informed Consent as shown on Springer.com

Author information

Authors and Affiliations

  1. Javed I. Kazi Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan

    Muhammed Ishaque, Rahma Rashid & Muhammed Mubarak

Authors
  1. Muhammed Ishaque
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahma Rashid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammed Mubarak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muhammed Mubarak.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ishaque, M., Rashid, R. & Mubarak, M. Gastrointestinal complications in renal transplant recipients detected by endoscopic biopsies in a developing country. Indian J Gastroenterol 34, 51–57 (2015). https://doi.org/10.1007/s12664-015-0537-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-015-0537-8

Keywords

Search

Navigation