title: Routine prophylaxis with proton pump inhibitors and post-transplant complications in kidney transplant recipients undergoing early corticosteroid withdrawal.
abstract: Surgical stress, corticosteroids, and mycophenolate may contribute to gastrointestinal ulcers/bleeding after kidney transplantation. Prophylactic acid suppression with H2RAs or PPIs is often utilized after transplantation, although unclear if truly indicated after early corticosteroid withdrawal (CSWD). PPIs have been associated with increased risks of Clostridium difficile infection (CDI), pneumonia, and acute rejection. This retrospective cohort study investigated benefits and risks of prolonged PPI use following kidney transplantation and included 286 kidney recipients undergoing CSWD within five d of transplant who were maintained on tacrolimus and mycophenolate mofetil/sodium. Patients on PPI before transplant, H2RA before/after transplant, and/or those with pre-transplant GI complications were excluded. A total of 171 patients received PPI>30 d, mean duration 287 ± 120 d (PPI group); 115 patients were not maintained on acid suppression (No-PPI group). GI ulceration and bleeding events were rare in PPI group (1.2% and 2.3%, respectively) and not observed in No-PPI group (p = NS). The incidence of infectious or hematological complications was not significantly different between groups. The PPI group experienced more biopsy-proven acute rejection (9.4% vs. 2.6%, p = 0.03). No direct benefit was observed with PPI in reducing the incidence of GI ulcers and bleeding events in kidney transplant recipients undergoing early CSWD. Further studies are needed to investigate the association of PPI and acute rejection.
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.|Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Alesa Y
authors.identifier: http://orcid.org/0000-0001-5722-9859
authors.initials: AY
authors.lastname: Courson
authors.affiliation: Division of Nephrology, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.|Department of Transplantation Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Lee
authors.affiliation: Division of Transplantation Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Meredith J
authors.initials: MJ
authors.lastname: Aull
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Transplantation Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Sandip
authors.initials: S
authors.lastname: Kapur
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.|Department of Pharmacy, Spectrum Health, Grand Rapids, MI, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: McDermott
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D066027:Transplant Recipients; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D054328:Proton Pump Inhibitors
keywords: infection; kidney transplantation; rejection; safety