General Surgery Unit, University Hospital of Catania, Catania 95123, Italy.
Pathology Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania 95123, Italy.
Aging (Albany NY). 2020 Dec 22;12(24):24709-24720. doi: 10.18632/aging.202345.
Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for the increased risk of gastrointestinal complications in kidney transplant recipients. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. This study evaluated the incidence of post-transplant gastrointestinal complications during screening colonoscopy. Kidney transplant recipients undergoing a colonoscopy for any reasons in the period 2014-2018 were included. Among the 134 patients completing the colonoscopy, 74 patients (56%) had an abnormal finding: an adenoma was found in 25 patients (18.6%), while 19 patients (14.1%) had colitis. Mycophenolic acid/related colitis was the most common colitis (6%), while 7 patients (5.2%) developed a inflammatory bowel disease. Patients with post-transplant colitis were younger and with shorter time from transplant compared to patients without colitis. In conclusions, immunosuppression may predispose kidney transplant recipients to an increased risk of post-transplant colitis. Diagnostic colonoscopy should be encouraged in all transplant patients with refractory diarrhea and gastrointestinal symptoms to allow a prompt diagnosis and a timely treatment, finally improving the quality of life and long-term outcomes of affected patients.
慢性免疫抑制可能会增加移植后感染和药物相关损伤的风险，也可能导致肾移植受者胃肠道并发症风险增加。由于大多数疾病具有相似的临床和组织学特征，因此区分各种类型的移植后结肠炎具有挑战性。本研究评估了在筛查结肠镜检查期间移植后胃肠道并发症的发生率。纳入了 2014 年至 2018 年间因任何原因接受结肠镜检查的肾移植受者。在完成结肠镜检查的 134 例患者中，74 例（56%）存在异常发现：25 例（18.6%）发现腺瘤，19 例（14.1%）存在结肠炎。霉酚酸/相关结肠炎是最常见的结肠炎（6%），而 7 例（5.2%）患者发展为炎症性肠病。与无结肠炎的患者相比，患有移植后结肠炎的患者更年轻，且移植后时间更短。总之，免疫抑制可能使肾移植受者更容易发生移植后结肠炎。对于有难治性腹泻和胃肠道症状的所有移植患者，应鼓励进行诊断性结肠镜检查，以便及时诊断和治疗，最终改善受影响患者的生活质量和长期预后。
