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Gastrointestinal (GI) disorders are common among patients with chronic kidney disease (CKD) and are associated with an increased risk of GI complications after kidney transplantation due to the immunosuppressive medications used, especially corticosteroids.
However, there is no consensus regarding upper GI endoscopy before kidney transplantation in all patients and most centers perform endoscopy only for symptomatic patients. The aim of this study is to investigate upper GI endoscopic and pathologic findings in CKD patients who are candidates for kidney transplantation.
We performed a retrospective cross-sectional study of all kidney transplant candidates evaluated at the transplant clinic between April 2021 and September 2023. Upper GI endoscopy was routinely performed for all patients as part of the kidney transplantation workup.
The clinical characteristics, upper GI endoscopic findings, and pathology results were obtained retrospectively from the medical records.
A total of 103 kidney transplant candidates were included; 73 (71%) were male and 30 (29%) were female, with a mean age of 35.8 years (range, 13-74 years). Most of the patients (88%) were previously on hemodialysis.
Endoscopy was normal in four patients only. The most common endoscopic findings were gastritis (70%), duodenitis (44.7%), erosive gastritis (20.4%), esophagitis (7.8%), and polyps (6.8%). Thirty-one patients had peptic ulcers; duodenal ulcer was more common than gastric ulcer seen in 24 patients.
Histopathology examination detected Helicobacter pylori (H. pylori) infection in 42.7%. Chronic gastritis (49.5%) was the most common pathology finding, followed by reactive gastropathy (17.5%). Interestingly, two patients had dysplasia along with chronic atrophic gastritis and a severe H. pylori infection, and one patient had dysplastic gastric polyps.
Our study revealed important endoscopic and pathologic findings in most kidney transplant candidates that require further management and evaluation before transplantation.
Since there is no good correlation between GI symptoms and gastroduodenal lesions, we suggest routine endoscopy as a pre-transplantation evaluation for all patients prepared for kidney transplantation.