Ensaroğlu Fatih, Harmancı Özgür, Öcal Serkan, Korkmaz Murat, Moray Gökhan, Özdemir Handan, Çolak Turan, Selçuk Haldun, Haberal Mehmet
From the Departments of Gastroenterology, Başkent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2015 Nov;13 Suppl 3:55-7. doi: 10.6002/ect.tdtd2015.O45.
We aimed to investigate the colonoscopy findings in patients after kidney transplant.
We retrospectively analyzed kidney transplant patients who had colonoscopy examinations for various indications between 2011 and 2015.
Eighty-one patients (25 women and 56 men) with a mean age of 39 years (range, 18-64 y) were identified. Mean follow-up after transplant was 9 years (range, 1-29 y). The most common indications for colonoscopy were diarrhea (41%), anemia (29%), gastrointestinal bleeding (12%), abdominal pain (12%), and unexplained weight loss (6%). Either colitis or ileitis or both were diagnosed in 20 patients (25%), whereas polyps were found in 9 patients (11%). One patient presented with hematochezia, which was diagnosed as cytomegalovirus colitis. The remaining cases of colitis or ileitis were diagnosed as nonspecific inflammation. Indications for colonoscopy were not correlated with age, duration after transplant, or use of immunosuppressive drugs. A subgroup analysis for mycophenolate-induced colitis found that 88% of patients used mycophenolate, but presence of colitis or ileitis had no statistical correlation with its use. In patients with poor gastrointestinal symptoms, the only significant predictor of presence of colitis or ileitis was a high C-reactive protein value (> 5 mg/dL; P = .02).
Incidence of colitis and/or ileitis is a relatively common finding in patients after kidney transplant. Opportunistic infections, mycophenolate use, and mild degree of indeterminate colitis or ileitis disease may be the underlying condition. Cytomegalovirus infection should be screened in all recipients because it may cause serious complications or death in chronically immunocompromised patients.
我们旨在研究肾移植患者的结肠镜检查结果。
我们回顾性分析了2011年至2015年间因各种适应证接受结肠镜检查的肾移植患者。
共纳入81例患者（25例女性和56例男性），平均年龄39岁（范围18 - 64岁）。移植后的平均随访时间为9年（范围1 - 29年）。结肠镜检查最常见的适应证为腹泻（41%）、贫血（29%）、胃肠道出血（12%）、腹痛（12%）和不明原因体重减轻（6%）。20例患者（25%）被诊断为结肠炎或回肠炎或两者兼有，而9例患者（11%）发现有息肉。1例患者出现便血，被诊断为巨细胞病毒性结肠炎。其余的结肠炎或回肠炎病例被诊断为非特异性炎症。结肠镜检查的适应证与年龄、移植后持续时间或免疫抑制药物的使用无关。对霉酚酸酯所致结肠炎的亚组分析发现，88%的患者使用了霉酚酸酯，但结肠炎或回肠炎的存在与其使用无统计学相关性。在胃肠道症状较差的患者中，结肠炎或回肠炎存在的唯一显著预测因素是高C反应蛋白值（>5mg/dL；P = 0.02）。
结肠炎和/或回肠炎的发生率在肾移植患者中是相对常见的发现。机会性感染、霉酚酸酯的使用以及轻度的不确定性结肠炎或回肠炎疾病可能是潜在病因。所有受者均应筛查巨细胞病毒感染，因为它可能在慢性免疫功能低下的患者中引起严重并发症或死亡。
