Cimetidine, posttransplant peptic ulcer complications, and renal allograft survival: a clinical and investigational perspective.

Upper gastrointestinal (G) tract complications have been a substantial cause of death following renal transplantation. Cimetidine, an H2 receptor antagonist, has been used in the posttransplant period to decrease this hazard. However, H2 receptor antagonists may enhance the immune response and be deleterious for the graft. The magnitude of the hazard of upper GI tract complications after renal transplantation was determined by reviewing 200 renal transplants. The effect of cimetidine treatment on the survival of canine renal allografts was investigated. The upper GI tract complication rate was 1.5% with one related death (0.5%). Treatment of dogs with cimetidine shortened the survival time of renal allografts (18.2 +/- 5.5 [SE] days to 12.5 +/- 2.2 days). Because upper GI tract complications are not a major hazard and H2 receptor antagonist therapy may decrease the survival of dog renal allografts, we believe prophylactic use of cimetidine is not indicated.