Treatment of peptic ulcer disease in the renal transplant patient.

This study reviews previous reports of peptic ulcer disease in kidney transplant recipients and includes our own experience. Between 1968-1976, 12 transplant centers reported on gastrointestinal complications occurring in 1853 renal transplant recipients. Among these are 52 patients in whom peptic ulcers developed before trnasplantation and 72 patients in whom peptic ulcers developed after transplantation. Included are 21 patients with peptic ulcer from 115 renal transplant recipients at VA Wadsworth Hospital. Patients who were operated upon for peptic ulcer before trnasplant were compared to patients with peptic ulcer before transplant but who were not operated upon. Ulcer recurrence was significantly lower in the operated group p less than .0003. Following transplantation 59 of 68 patients with peptic ulcer disease presented with bleeding or perforation. Mortality was high: 31 deaths in 72 patients (43%). Symptoms usually occurred early, 74% in 6 months, but 19% occurred after one year. The mortality from duodenal, gastric, combined gastric and duodenal and recurrent ulcers did not differ significantly. Elective surgery is indicated for peptic ulcer when demonstrated before or after kidney transplantation.