Introduction: Kidney transplant offers children with end-stage renal failure an improved quality of life compared to a life on dialysis; but despite its advantages, post-transplant patients encounter various adverse effects including gastrointestinal (GI) manifestations. The incidence of GI manifestations among the general pediatric population is reported to be 23-27%.
Objectives: This study aimed to determine the incidence of GI manifestations among a large Israeli pediatric kidney transplant cohort and identify risk factors associated with them.
Methods: A retrospective single-center cohort chart review study that was conducted on pediatric kidney transplant recipients between the ages 2-21 years who were followed at Schneider Children’s Medical Center of Israel (SCMCI) between the years 2011-2021. Multi-organ transplanted patients were excluded from the study. The data we collected was in regard only to the first transplant of the patients. We defined GI complications as chronic diarrhea (which was over 2 weeks), mouth or GI ulcers, and persistent abdominal pain which required imaging workup. Cumulative incidence of GI complications was estimated using the Kaplan-Meier method.
Results: A total of 247 patients underwent a kidney transplant at SCMCI throughout the study period, of them 120 patients comprised the study population. The study’s population was comprised of 35% (n=42) females, a mean age of 11.13 years at transplant, and 67.5% (n=81) patients that had congenital anomalies of the kidneys and urinary tracts (CAKUT) as transplant indication. During the follow-up, 36.7% (n=44) of the patients developed GI complications. Chronic diarrhea was the most common GI manifestation and was present in 35.8% (n=43) of those patients. Risk factors for developing chronic diarrhea were age younger than 10.5 years at transplantation and the use of mycophenolate mofetil (MMF) tablets.
Conclusion: The incidence of GI manifestations among pediatric kidney transplant patients is greater than among the general pediatric population. The most common GI manifestation was chronic diarrhea and the risk factors for developing chronic diarrhea were age under 10.5 years and MMF tablets. Thus, EC-MPS (Myfortic) can be used as primary immunosuppression among patients who can take pills. Further multicentered research on a larger population should be conducted to examine other GI manifestations.