Upper Gastrointestinal Bleeding During the First Month After Renal Transplantation in the Mycophenolate Mofetil Era

Upper gastrointestinal (GI) bleeding remains a significant cause of mortality and
morbidity among renal transplant recipients. We retrospectively analyzed the records of
patients who received renal transplantations between January 2001 and July 2007 using
mycophenolate mofetil (MMF) in their immunosuppressive regimens. The following data
were recorded for those subjects with upper GI bleeding during the first month after
transplantation (group B, cases): age, sex, acute rejection episodes, pretransplant upper GI
endoscopic findings, Helicobacter positivity, and cytomegalovirus (CMV) seropositivity.
The same parameters were studied among a group of patients, who did not have a history
of upper GI bleeding (group A, controls). A statistical analysis was performed to ascertain
potential risk factors. Among 523 patients (311 females, 212 males) of age range 7 to 58
years, 27 (5.2%) had upper GI bleeding: 13 males and 14 females of mean age 44 � 12
years. The most frequent endoscopic finding was erosive gastritis (n � 13; 48.1%) followed
by duodenal ulcers. Binary logistic regression analysis comparing the 2 groups showed that
acute rejection episodes (P � .015) and active CMV infection (P � .046) were the most
prominent risk factors for upper GI bleeding during the first month after renal
transplantation