Short-term high-dose corticosteroids and gastroduodenal mucosa

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Abstract
In order to evaluate the effect of a short-term high-dose corticosteroid therapy on the gastric and duodenal mucosa, 30 consecutive renal transplant recipients (mean age 39.1 years, 10 women and 20 men) underwent an endoscopic examination of gastroduodenal mucosa 12 and 30 days after renal transplantation. In addition to the postoperative immunosuppressive medication (methylprednisolone and azathioprine), antacids and H2-receptor antagonists were given. Seventeen patients showed no signs of acute rejection, whereas 11 patients experienced one episode and 2 patients two episodes of rejection during endoscopic follow-up. Each rejection episode was treated with a high-dose regimen of methylprednisolone. The two groups of patients studied, i.e., those who did and those who did not experience rejection, were matched for age, sex, period of preoperative dialysis treatment, period of postoperative time elapsed from transplantation, serum creatinine level, and dose of methylprednisolone or azathioprine at the beginning of the endoscopic follow-up, as well as for ulcer prophylactic medication during follow-up. The gastroduodenal mucosa was similar in the two patient groups, both endoscopically and histologically, at the start of the study. During the observation period of 2 weeks, erosive antral gastritis increased significantly in patients who did not experience rejection, whereas in patients with acute rejection and concomitant high-dose corticosteroid therapy, the antral mucosa remained nearly unchanged. Also, the gastric corpus and the duodenum remained unaltered in both groups during follow-up. No ulcer complications occurred in the series. Thus, a high-dose short-term corticosteroid treatment does not seem to be related to grossly harmful side effects in the gastroduodenal mucosa in the immediate post-transplant phase after renal transplantation. This suggests that the current policy of active treatment of renal failure, including antiulcer prophylaxis with H2-receptor antagonists and improved immunosuppressive medication, renders the gastroduodenal mucosa resistant enough to also tolerate the acute post-transplant period well.