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VOLUME 13 , ISSUE 1 ( January-June, 2023 ) > List of Articles


The Role of Gastroenterologists in Preoperative Assessment and Management of Prospective Renal Transplantation Candidates

Suprabhat Giri, Kumar Avijeet Dash, Jijo Varghese, Shivaraj Afzalpurkar

Keywords : Cholelithiasis, Hepatitis B virus, Hepatitis C virus, Inflammatory bowel disease, Renal transplant

Citation Information : Giri S, Dash KA, Varghese J, Afzalpurkar S. The Role of Gastroenterologists in Preoperative Assessment and Management of Prospective Renal Transplantation Candidates. Euroasian J Hepatogastroenterol 2023; 13 (1):18-25.

DOI: 10.5005/jp-journals-10018-1390

License: CC BY-NC 4.0

Published Online: 03-08-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Renal transplant is the most common organ transplant worldwide, accounting for 65% of the total number of transplants. End-stage renal disease (ESRD) often has multiple significant comorbidities. Among the gastrointestinal (GI) disorders, peptic ulcer disease (PUD), cholelithiasis, and colon and liver diseases increase the risk of posttransplant morbidity. Potential renal transplantation (RT) candidates need a multidisciplinary assessment of coexisting illnesses, which may affect the perioperative risk and survival after transplantation. Successful outcome of RT depends on careful selection of the recipients by a thorough medical evaluation and screening. This review summarizes the role of gastroenterologists and hepatologists in preoperative assessment and management of renal transplant recipients.

  1. Abecassis M, Bartlett ST, Collins AJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) Conference. Clin J Am Soc Nephrol 2008;3(2):471–480. DOI: 10.2215/CJN.05021107.
  2. Global Observatory on Donation and Transplantation. Available at: Accessed on: 2 August 2022.
  3. Miskulin D, Bragg–Gresham J, Gillespie BW, et al. Key comorbid conditions that are predictive of survival among hemodialysis patients. Clin J Am Soc Nephrol 2009;4(11):1818–1826. DOI: 10.2215/CJN.00640109.
  4. Bouthot BA. Gastrointestinal evaluation in renal transplant candidates. Sem Col Rect Surg 2002;13(3):197–201. DOI: 10.1053/scrs.2002.127393.
  5. Rinonce HT, Yano Y, Utsumi T, et al. Hepatitis B and C virus infection among hemodialysis patients in Yogyakarta, Indonesia: Prevalence and molecular evidence for nosocomial transmission. J Med Virol 2013;85(8):1348–1361. DOI: 10.1002/jmv.23581.
  6. Garthwaite E, Reddy V, Douthwaite S, et al. Clinical practice guideline management of blood borne viruses within the haemodialysis unit. BMC Nephrol 2019;20:388. DOI: 10.1186/s12882-019-1529-1.
  7. Adane T, Getawa S. The prevalence and associated factors of hepatitis B and C virus in hemodialysis patients in Africa: A systematic review and meta-analysis. PLoS One 2021;16(6):e0251570. DOI: 10.1371/journal.pone.0251570.
  8. El-Sherif A, Elbahrawy A, Aboelfotoh A, et al. High false-negative rate of anti-HCV among Egyptian patients on regular hemodialysis. Hemodial Int 2012;16(3):420–427. DOI: 10.1111/j.1542-4758.2011.00662.x.
  9. Makvandi M. Update on occult hepatitis B virus infection. World J Gastroenterol 2016;22(39):8720–8734. DOI: 10.3748/wjg.v22.i39.8720.
  10. Liang CC, Muo CH, Wang IK, et al. Peptic ulcer disease risk in chronic kidney disease: Ten-year incidence, ulcer location, and ulcerogenic effect of medications. PLoS One 2014;9(2):e87952. DOI: 10.1371/journal.pone.0087952.
  11. Shin SP, Bang CS, Lee JJ, et al. Helicobacter pylori infection in patients with chronic kidney disease: A systematic review and meta-analysis. Gut Liver 2019;13(6):628–641. DOI: 10.5009/gnl18517.
  12. Sarkio S, Halme L, Kyllönen L, et al. Severe gastrointestinal complications after 1,515 adult kidney transplantations. Transpl Int 2004;17(9):505–510. DOI: 10.1007/s00147-004-0748-x.
  13. Telkes G, Peter A, Tulassay Z, et al. High frequency of ulcers, not associated with Helicobacter pylori, in the stomach in the first year after kidney transplantation. Nephrol Dial Transplant 2011;26(2): 727–732. DOI: 10.1093/ndt/gfq401.
  14. Chadban SJ, Ahn C, Axelrod DA, et al. KDIGO clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation 2020;104(4S.1 Suppl. 1):S11–S103. DOI: 10.1097/TP.0000000000003136.
  15. Sotoudehmanesh R, Ali Asgari A, Ansari R, et al. Endoscopic findings in end-stage renal disease. Endoscopy 2003;35(6):502–505. DOI: 10.1055/s-2003-39672.
  16. Netto JPH, Pinheiro JPS, Ferrari ML, et al. Upper gastrointestinal alterations in kidney transplant candidates. J Bras Nefrol 2018;40(3):266–272. DOI: 10.1590/2175-8239-JBN-3829.
  17. Bibbins–Domingo K, Grossman DC, Curry SJ, et al. Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA 2016;315(23):2564–2575. DOI: 10.1001/jama. 2016.5989.
  18. Wong G, Hope RL, Howard K, et al. One-time fecal immunochemical screening for advanced colorectal neoplasia in patients with CKD (DETECT study). J Am Soc Nephrol 2019;30(6):1061–1072. DOI: 10.1681/ASN.2018121232.
  19. Komaki Y, Komaki F, Micic D, et al. Risk of colorectal cancer in chronic kidney disease: A systematic review and meta-analysis. J Clin Gastroenterol 2018;52(9):796–804. DOI: 10.1097/MCG.00000 00000000880.
  20. Kobiela J, Dobrzycka M, Danielewicz R, et al. Colonoscopy as part of pre-transplant work-up in successful kidney transplant candidates: Single-center experience and review of literature. Ann Transplant 2018;23:782–788. DOI: 10.12659/AOT.910658.
  21. Coccolini F, Catena F, Di Saverio S, et al. Colonic perforation after renal transplantation: Risk factor analysis. Transplant Proc 2009;41(4): 1189–1190. DOI: 10.1016/j.transproceed.2009.02.064.
  22. Oor JE, Atema JJ, Boermeester MA, et al. A systematic review of complicated diverticulitis in post-transplant patients. J Gastrointest Surg 2014;18(11):2038–2046. DOI: 10.1007/s11605-014-2593-2.
  23. Scotti A, Santangelo M, Federico S, et al. Complicated diverticulitis in kidney transplanted patients: analysis of 717 cases. Transplant Proc 2014;46(7):2247–2250. DOI: 10.1016/j.transproceed.2014.07.044.
  24. Rencuzogullari A, Ozuner G, Binboga S, et al. Colonic diverticulosis and diverticulitis in renal transplant recipients: Management and long-term outcomes. Am Surg 2017;83(3):303–307. PMID: 28316316.
  25. Pourfarziani V, Mousavi–Nayeeni SM, Ghaheri H, et al. The outcome of diverticulosis in kidney recipients with polycystic kidney disease. Transplant Proc 2007;39(4):1054–1056. DOI: 10.1016/j.transproceed.2007.02.007.
  26. Corica D, Romano C. Renal involvement in inflammatory bowel diseases. J Crohns Colitis 2016;10(2):226–235. DOI: 10.1093/ecco-jcc/jjv138.
  27. Grupper A, Schwartz D, Baruch R, et al. Kidney transplantation in patients with inflammatory bowel diseases (IBD): Analysis of transplantation outcome and IBD activity. Transpl Int 2019;32(7): 730–738. DOI: 10.1111/tri.13415.
  28. Schnitzler F, Friedrich M, Stallhofer J, et al. Solid organ transplantation in patients with inflammatory bowel diseases (IBD): Analysis of transplantation outcome and IBD activity in a large single center cohort. PLoS One 2015;10(8):e0135807. DOI: 10.1371/journal.pone.0135807.
  29. Verdonk RC, Dijkstra G, Haagsma EB, et al. Inflammatory bowel disease after liver transplantation: Risk factors for recurrence and de novo disease. Am J Transplant 2006;6(6):1422–1429. DOI: 10.1111/j.1600-6143.2006.01333.x.
  30. Laine L, Kaltenbach T, Barkun A, et al. SCENIC guideline development panel. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015;148(3):639–651.e28. DOI: 10.1053/j.gastro. 2015.01.031.
  31. Chen HJ, Wang JJ, Tsay WI, et al. Epidemiology and outcome of acute pancreatitis in end-stage renal disease dialysis patients: A 10-year national cohort study. Nephrol Dial Transplant 2017;32(10):1731–1736. DOI: 10.1093/ndt/gfw400.
  32. Wang IK, Lai SW, Lai HC, et al. Risk of and fatality from acute pancreatitis in long-term hemodialysis and peritoneal dialysis patients. Perit Dial Int 2018;38(1):30–36. DOI: 10.3747/pdi.2016.00313.
  33. Kroner PT, Mareth K, Raimondo M, et al. Acute pancreatitis in advanced chronic kidney disease and kidney transplant recipients: Results of a US nationwide analysis. Mayo Clin Proc Innov Qual Outcomes 2019;3(2):160–168. DOI: 10.1016/j.mayocpiqo.2019.03.006.
  34. Russell TA, Park S, Agopian VG, et al. Peritransplant pancreatitis: A marker of high mortality and graft failure in liver transplant patients. Liver Transpl 2017;23:925–932. DOI: 10.1002/lt.24760.
  35. Knoll G, Cockfield S, Blydt–Hansen T, et al. Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ 2005;173(10):1181–1184. DOI: 10.1503/cmaj. 051291.
  36. Barry K. Chronic pancreatitis: Diagnosis and treatment. Am Fam Physician 2018;97(6):385–393. PMID: 29671537.
  37. Jiang AT, BHSc, Rowe N, et al. Simultaneous pancreas–kidney transplantation: The role in the treatment of type 1 diabetes and end-stage renal disease. Can Urol Assoc J 2014;8(3–4):135–138. DOI: 10.5489/cuaj.1597.
  38. Lai SW, Liao KF, Lai HC, et al. The prevalence of gallbladder stones is higher among patients with chronic kidney disease in Taiwan. Medicine (Baltimore) 2009;88:46–51. DOI: 10.1097/MD.0b013e318194183f.
  39. Kazama JJ, Kazama S, Koda R, et al. The risk of gallbladder stone formation is increased in patients with predialysis chronic kidney disease but not those undergoing chronic hemodialysis therapy. Nephron Clin Pract 2009;111(3):c167–c172. DOI: 10.1159/000199456.
  40. Tsai CH, Wu JS, Chang YF, et al. The number of metabolic abnormalities associated with the risk of gallstones in a non-diabetic population. PLoS One 2014;9(3):e90310. DOI: 10.1371/journal.pone.0090310.
  41. Melvin WS, Meier DJ, Elkhammas EA, et al. Prophylactic cholecystectomy is not indicated following renal transplantation. Am J Surg 1998;175(4):317–319. DOI: 10.1016/s0002-9610(98)00009-9.
  42. Jackson T, Treleaven D, Arlen D, et al. Management of asymptomatic cholelithiasis for patients awaiting renal transplantation. Surg Endosc 2005;19(4):510–513. DOI: 10.1007/s00464-004-8817-x.
  43. Pham PT, Pham SV, Pham PA, et al. Medical evaluation of the adult kidney transplant candidate. In: Current Issues and Future Direction in Kidney Transplantation, Thomas Rath, editor. IntechOpen 2013. DOI: 10.5772/54736.
  44. Friedman LS. The risk of surgery in patients with liver disease. Hepatology 1999;29(6):1617–1623. DOI: 10.1002/hep.510290639.
  45. Harville DD, Summerskill WH. Surgery in acute hepatitis. Causes and effects. JAMA 1963;184:257–261. DOI: 10.1001/jama.1963. 03700170049006.
  46. Murali AR, Kotwal V, Chawla S. Chronic hepatitis E: A brief review. World J Hepatol 2015;7(19):2194–2201. DOI: 10.4254/wjh.v7.i19.2194.
  47. Kraef C, Schlein C, Hiller J, et al. Course of HEV viremia and anti-HEV IgM/IgG response in asymptomatic blood donors. J Clin Virol 2018;105:26–30. DOI: 10.1016/j.jcv.2018.05.013.
  48. Powell–Jackson P, Greenway B, Williams R. Adverse effects of exploratory laparotomy in patients with unsuspected liver disease. Br J Surg 1982;69(8):449–451. DOI: 10.1002/bjs.1800690805.
  49. Jones JM, Kracalik I, Levi ME, et al. Assessing solid organ donors and monitoring transplant recipients for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection: U.S. Public Health Service Guideline, 2020. MMWR Recomm Rep 2020;69(4):1–16. DOI: 10.15585/mmwr.rr6904a1.
  50. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 2018;67(4):1560–1599. DOI: 10.1002/hep.29800.
  51. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017;67(2):370–398. DOI: 10.1016/j.jhep.2017.03.021.
  52. Rostaing L, Modesto A, Baron E, et al. Acute renal failure in kidney transplant patients treated with interferon alpha 2b for chronic hepatitis C. Nephron 1996;74(3):512–516. DOI: 10.1159/000189444.
  53. European Association for the Study of the Liver, Clinical Practice Guidelines Panel, EASL Governing Board representative. EASL recommendations on treatment of hepatitis C: Final update of the series. J Hepatol 2020;73(5):1170–1218. DOI: 10.1016/j.jhep. 2020.08.018.
  54. Taneja S, Borkakoty A, Rathi S, et al. Assessment of liver fibrosis by transient elastography should be done after hemodialysis in end stage renal disease patients with liver disease. Dig Dis Sci 2017;62(11):3186–3192. DOI: 10.1007/s10620-017-4777-6.
  55. Arrayhani M, Sqalli T, Tazi N, et al. Non invasive assessment of liver fibrosis in chronic hemodialysis patients with viral hepatitis C. Pan Afr Med J 2015;22:273. DOI: 10.11604/pamj.2015.22.273.2311.
  56. Goldberg DS, Abt PL, Blumberg EA, et al. Trial of transplantation of HCV-infected kidneys into uninfected recipients. N Engl J Med 2017;376(24):2394–2395. DOI: 10.1056/NEJMc1705221.
  57. Jandovitz N, Nair V, Grodstein E, et al. Hepatitis C-positive donor to negative recipient kidney transplantation: A real-world experience. Transpl Infect Dis 2021;23(3):e13540. DOI: 10.1111/tid.13540.
  58. Li M, Chen J, Fang Z, et al. Sofosbuvir-based regimen is safe and effective for hepatitis C infected patients with stage 4–5 chronic kidney disease: A systematic review and meta-analysis. Virol J 2019;16(1):34. DOI: 10.1186/s12985-019-1140-x.
  59. Jabbari SM, Maajani K, Merat S, et al. An updated systematic review and meta-analysis on efficacy of Sofosbuvir in treating hepatitis C-infected patients with advanced chronic kidney disease. PLoS One 2021;16(2):e0246594. DOI: 10.1371/journal.pone.0246594.
  60. Le MH, Yeo YH, Li X, et al. 2019 Global NAFLD prevalence: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2021:20(12):2809–2817.e28. DOI: 10.1016/j.cgh.2021.12.002.
  61. Chinnadurai R, Ritchie J, Green D, et al. Non-alcoholic fatty liver disease and clinical outcomes in chronic kidney disease. Nephrol Dial Transpl 2019;34(3):449–457. DOI: 10.1093/ndt/gfx381.
  62. Mikolasevic I, Racki S, Bubic I, et al. Chronic kidney disease and nonalcoholic fatty liver disease proven by transient elastography. Kidney Blood Press Res 2013;37(4–5):305–310. DOI: 10.1159/000350158.
  63. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67(1):328–357. DOI: 10.1002/hep.29367.
  64. Paramesh AS, Davis JY, Mallikarjun C, et al. Kidney transplantation alone in ESRD patients with hepatitis C cirrhosis. Transplantation 2012;94(3):250–254. DOI: 10.1097/TP.0b013e318255f890.
  65. Parsikia A, Campos S, Khanmoradi K, et al. Equal 3-year outcomes for kidney transplantation alone in HCV-positive patients with cirrhosis. Int Surg 2015;100(1):142–154. DOI: 10.9738/INTSURG-D-13- 00231.1.
  66. Patel A, Harrison S, Rudraraju M. Graft outcomes in kidney transplantation alone with concomitant cirrhosis. Jour Gastro Hepat Res 2016;5(2):2001–2004. DOI: 10.17554/j.issn.2224-3992.2016.05.471.
  67. Cullaro G, Sharma P, Jo J, et al. Temporal trends and evolving outcomes after simultaneous liver–kidney transplantation: Results from the US SLKT Consortium. Liver Transpl 2021;27(11):1613–1622. DOI: 10.1002/lt.26232.
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