Outcomes In Kidney Transplant Recipients Receiving A Proton Pump Inhibitor For Gastrointestinal Bleeding Prophylaxis At St. Joseph’s Healthcare Hamilton

Abstract

Background/Objectives: Gastrointestinal complications such as gastrointestinal bleeds can occur in up to 20% of renal transplant recipients, resulting in hospitalizations, graft loss and death. To date, the impact of prescribing proton pump inhibitors (PPIs) for gastrointestinal bleed prophylaxis in the kidney transplant population at St. Joseph’s Healthcare Hamilton (SJHH) has not been evaluated. Methods: We conducted a retrospective chart review of patients admitted for kidney transplant surgery between November 1st 2019 to November 30th 2023. The electronic health record (EPIC Systems) was reviewed for outcomes related to PPI use in the first 6-month period post-transplant. Results: 513 transplant patients were analyzed (median age 57 years [IQR 44-66], 63.4% male). 200 patients were prescribed a PPI prior to transplantation, 239 patients were initiated on a PPI during the transplant admission, 22 patients post-discharge, and 52 patients were never prescribed a PPI. A total of 11 patients experienced a gastrointestinal bleed: eight patients from the no PPI group and three patients in the PPI group (15.38% vs 0.65%, p <0.001). The median time to gastrointestinal bleed post-transplant was 16.5 days [IQR 10.75-25.25]. The median dose of prednisone at the time of bleed was 27.5 mg [IQR 20-30]. The odds ratio of experiencing a gastrointestinal bleed without a PPI was 27.8 (95% CI [7.11-108]), p <0.001. Using a PPI resulted in a risk reduction of 1.18 (95% CI [1.05-1.32]), p <0.001. At 6 months post-transplant, 30% of those prescribed a PPI post-transplant discontinued their PPIs. For those previously prescribed a PPI, the discontinuation rate was 9.5%. There were 175 reported incidences of an adverse event in patients prescribed a PPI (e.g. hypomagnesemia, community acquired pneumonia, clostridium difficile infection). Conclusion: In this cohort of SJHH kidney transplant patients, the routine use of PPIs provided gastroprotection from GI bleeds early in the post-op period.