title: Increased risk of graft failure in kidney transplant recipients after a diagnosis of dyspepsia or gastroesophageal reflux disease.
abstract: BACKGROUND
  Gastrointestinal complications are common in patients who undergo kidney transplantation and may affect posttransplant outcomes. We examined the incidence and predictors of gastroesophageal reflux disease (GERD) and dyspepsia and their associations with graft survival and mortality after transplant.
  
  
  METHODS
  We examined United States Renal Data System data and Medicare billing claims to identify diagnoses of dyspepsia and GERD among Medicare beneficiaries transplanted in 1995-2002 (n=42,257). Among GERD cases, we identified patients with reflux esophagitis (RE). We determined independent predictors of upper gastrointestinal complications and modeled these conditions as time-dependent outcomes predictors with Cox regression.
  
  
  RESULTS
  The 3-year cumulative incidences of GERD, RE, and dyspepsia were 20%, 5%, and 6%, respectively. Overall, 23% of transplant recipients received a diagnosis of at least one of these complications by 3 years after transplant. Female gender and a pretransplant upper gastrointestinal disease diagnosis predicted posttransplant gastrointestinal complications. Older age, obesity, Caucasian, and African-American race were associated to increased risk of developing GERD. Patients diagnosed with any of the examined upper gastrointestinal complications experienced an increased risk of graft-failure (hazard ratio 1.58; 95% confidence interval 1.48-1.69) and death (hazard ratio 1.61; 95% confidence interval 1.46-1.77).
  
  
  CONCLUSIONS
  Upper gastrointestinal complications are relatively common after kidney transplantation and are associated with a significantly increased risk of graft loss and death. Further research is needed to elucidate mechanisms underlying the observed adverse prognoses conferred by diagnosis of upper gastrointestinal complications after kidney transplant.
authors.affiliation: Center for Outcomes Research, Saint Louis University, St. Louis, MO 63104, USA.
authors.forename: Luca
authors.initials: L
authors.lastname: Neri
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Rocca Rey
authors.forename: Brett W
authors.initials: BW
authors.lastname: Pinsky
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Paolo R
authors.initials: PR
authors.lastname: Salvalaggio
authors.forename: Gerardo
authors.initials: G
authors.lastname: Machnicki
authors.forename: Lisa
authors.initials: L
authors.lastname: Willoughby
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Burroughs
authors.forename: Steven K
authors.initials: SK
authors.lastname: Takemoto
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
mesh_terms: D000293:Adolescent; D000328:Adult; D004415:Dyspepsia / Q000175:diagnosis*; D005260:Female; D005764:Gastroesophageal Reflux / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome