title: Gastrointestinal disorders after renal transplantation.
abstract: BACKGROUND
  Gastrointestinal disorders (GDs) are common in renal transplant recipients. The main cause of GDs seems to be the use of immunosuppressive medications, especially mycophenolic acid in the form of mycophenolate mofetil (MMF).
  
  
  OBJECTIVE
  The aim of this study was to estimate the frequency and severity of GDs in renal allograft recipients with the use of the Gastrointestinal Symptom Rating Scale (GSRS).
  
  
  METHODS
  Eighty-five renal allograft recipients, 50 ± 12 years old, treated with methylprednisolone, calcineurin inhibitor (cyclosporine [CsA], n = 42; tacrolimus (TAC), n = 43), and MMF were studied.
  
  
  RESULTS
  At the time of completion of the GSRS questionnaire, 38 of the 85 patients (45%) already had their MMF dose reduced because of GDs. Only 15 patients (18%) were totally free from GDs. The most frequent and severe GDs recorded were indigestion and diarrhea who were significantly more frequent in women (P = .045). GDs were recorded in patients receiving both standard and reduced dose of MMF. MMF dose was significantly associated only with diarrhea. Although TAC-treated patients had the highest mean GSRS scores, no statistically significant differences were observed compared with CsA-treated patients. In 31 patients, MMF was replaced by enteric-coated mycophenolate sodium (EC-MPS) and new questionnaires were completed 1 month later. Significant improvement in total and all subscores of GSRS was demonstrated (P < .001). Although EC-MPS dose tolerated by the patients was higher than MMF dose, the difference was not statistically significant.
  
  
  CONCLUSIONS
  Female sex and the use of MMF, especially in combination with TAC, are related to the occurrence of severe gastrointestinal symptoms. Substitution of MMF with EC-MPS significantly reduces the severity of symptoms and permits the use of higher doses.
authors.affiliation: University Hospital of Patras, Transplantation Center, Patras, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Savvidaki
authors.affiliation: University Hospital of Patras, Transplantation Center, Patras, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Papachristou
authors.affiliation: University Hospital of Patras, Transplantation Center, Patras, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Kazakopoulos
authors.affiliation: University Hospital of Patras, Transplantation Center, Patras, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Papasotiriou
authors.affiliation: University Hospital of Patras, Transplantation Center, Patras, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Vardoulaki
authors.affiliation: University Hospital of Patras, Transplantation Center, Patras, Greece. Electronic address: dgoumenos@upatras.gr.
authors.forename: D S
authors.initials: DS
authors.lastname: Goumenos
mesh_terms: D064591:Allografts; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006084:Graft Rejection / Q000517:prevention & control*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents