Increased risk of graft failure in kidney transplant recipients after a diagnosis of dyspepsia or gastroesophageal reflux disease

Luca Neri, Lisa A Rocca Rey, Brett W. Pinsky, Krista L. Lentine, Paolo R. Salvalaggio, Gerardo Machnicki, Lisa Willoughby, Thomas E. Burroughs, Steven K. Takemoto, Mark A. Schnitzler

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)344-352
Number of pages9
JournalTransplantation
Volume85
Issue number3
DOIs
Publication statusPublished - Feb 2008

Fingerprint

Dyspepsia
Gastroesophageal Reflux
Renal Insufficiency
Transplants
Peptic Esophagitis
Medicare
Kidney Transplantation
Confidence Intervals
Kidney
Gastrointestinal Diseases
Incidence
Graft Survival
Information Systems
African Americans
Obesity
Transplant Recipients
Mortality
Research

Keywords

  • Dyspepsia
  • Gastro-esophageal reflux disease
  • Gastrointestinal complications
  • Graft survival
  • Kidney transplantation
  • USRDS

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Increased risk of graft failure in kidney transplant recipients after a diagnosis of dyspepsia or gastroesophageal reflux disease. / Neri, Luca; Rey, Lisa A Rocca; Pinsky, Brett W.; Lentine, Krista L.; Salvalaggio, Paolo R.; Machnicki, Gerardo; Willoughby, Lisa; Burroughs, Thomas E.; Takemoto, Steven K.; Schnitzler, Mark A.

In: Transplantation, Vol. 85, No. 3, 02.2008, p. 344-352.

Research output: Contribution to journalArticle

Neri, L, Rey, LAR, Pinsky, BW, Lentine, KL, Salvalaggio, PR, Machnicki, G, Willoughby, L, Burroughs, TE, Takemoto, SK & Schnitzler, MA 2008, 'Increased risk of graft failure in kidney transplant recipients after a diagnosis of dyspepsia or gastroesophageal reflux disease', Transplantation, vol. 85, no. 3, pp. 344-352. https://doi.org/10.1097/TP.0b013e318160d4c4
Neri, Luca ; Rey, Lisa A Rocca ; Pinsky, Brett W. ; Lentine, Krista L. ; Salvalaggio, Paolo R. ; Machnicki, Gerardo ; Willoughby, Lisa ; Burroughs, Thomas E. ; Takemoto, Steven K. ; Schnitzler, Mark A. / Increased risk of graft failure in kidney transplant recipients after a diagnosis of dyspepsia or gastroesophageal reflux disease. In: Transplantation. 2008 ; Vol. 85, No. 3. pp. 344-352.
@article{422186980f474239b1c429f6ef49aec3,
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.",
keywords = "Dyspepsia, Gastro-esophageal reflux disease, Gastrointestinal complications, Graft survival, Kidney transplantation, USRDS",
author = "Luca Neri and Rey, {Lisa A Rocca} and Pinsky, {Brett W.} and Lentine, {Krista L.} and Salvalaggio, {Paolo R.} and Gerardo Machnicki and Lisa Willoughby and Burroughs, {Thomas E.} and Takemoto, {Steven K.} and Schnitzler, {Mark A.}",
year = "2008",
month = "2",
doi = "10.1097/TP.0b013e318160d4c4",
language = "English",
volume = "85",
pages = "344--352",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Increased risk of graft failure in kidney transplant recipients after a diagnosis of dyspepsia or gastroesophageal reflux disease

AU - Neri, Luca

AU - Rey, Lisa A Rocca

AU - Pinsky, Brett W.

AU - Lentine, Krista L.

AU - Salvalaggio, Paolo R.

AU - Machnicki, Gerardo

AU - Willoughby, Lisa

AU - Burroughs, Thomas E.

AU - Takemoto, Steven K.

AU - Schnitzler, Mark A.

PY - 2008/2

Y1 - 2008/2

N2 - 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.

AB - 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.

KW - Dyspepsia

KW - Gastro-esophageal reflux disease

KW - Gastrointestinal complications

KW - Graft survival

KW - Kidney transplantation

KW - USRDS

UR - http://www.scopus.com/inward/record.url?scp=40049085792&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40049085792&partnerID=8YFLogxK

U2 - 10.1097/TP.0b013e318160d4c4

DO - 10.1097/TP.0b013e318160d4c4

M3 - Article

VL - 85

SP - 344

EP - 352

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 3

ER -