The influence of immunosuppression on peptic ulceration following renal transplantation and the role of endoscopy.

Peptic ulceration is common in patients undergoing renal transplantation. With a change in routine immunosuppression from azathioprine and steroids to cyclosporin, or cyclosporin and low-dose steroids and azathioprine, less peptic ulceration might be expected. This was investigated in two groups of patients undergoing renal transplantation. Group 1 (n = 90) received azathioprine and prednisolone; Group 2 (n = 44) received cyclosporin and low-dose azathioprine and prednisolone. Patients from both groups were endoscoped 7-14 days after operation, when peptic ulceration, oesophagitis, gastritis, and duodenitis were assessed. Whilst Group 2 differed significantly in receiving more methylprednisolone than Group 1 (P less than 0.05), there was no difference between the two groups with regard to the incidence of peptic ulceration or inflammatory lesions. In both groups there was a trend for those treated with methylprednisolone for rejection to develop ulcers or inflammatory lesions when a total dose of more than 2 g had been given by the time of endoscopy. Any possible reduction in the incidence of peptic ulceration after transplantation is outweighed by the continued use of high-dose methylprednisolone to treat episodes of rejection. The true incidence of peptic ulceration after transplantation is much higher than if presenting symptoms alone are the starting point for investigation. Regular post-transplantation endoscopy allows prompt diagnosis and treatment, with attainment of a very low mortality rate (0.75% overall, or 4% in those with peptic ulcers) from peptic ulceration in patients undergoing renal transplantation.