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신장이식 환자에게 위장관계 증상 예방 목적으로 투여하는 Proton Pump Inhibitors (PPIs) 안전성 비교분석

Comparative Analysis of the Safety of Proton Pump Inhibitors (PPIs) Prophylaxis to Prevent Gastrointestinal Complications in Kidney Transplant Recipients

김효진|안지현|김재송|손은선|조현경
한국병원약사회 (The Korean Society of Health-System Pharmacists)|2020.02|병원약사회지 (Journal of Korean Society of Health-System Pharmacists)|제37권 제1호|pp. 20-33|DOI 10.32429/jkshp.2020.37.1.002

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키워드

SafetyKidney transplantationProton pump inhibitorGraft rejection

초록

Background : Proton pump inhibitors (PPIs) are often prescribed after kidney transplantation to prevent gastrointestinal complications despite the lack of evidence. There are conflicting opinions reporting on an association between PPI prophylaxis and acute rejection. Additionally, several studies have reported increased risk of infections and hematological events of PPI use. The purpose of this study was to investigate risks of PPI prophylaxis early after kidney transplantation. Methods : We retrospectively analyzed the records of patients who received kidney transplantations September 2016-February 2018 using standard immunosuppressive regimens. The endpoints were to compare the incidence of adverse events, biopsy-proven acute rejection (BPAR), and graft failure within three months and six months after transplantation. Results : A total of 190 recipients were included in this study; of which 56 were included in the PPI group and 134 were included in the no-PPI group. Seven (12.5%) patients in the PPI group and five (3.7%) patients in the no-PPI group developed BPAR within three months, which was statistically significant (p=0.044). There was no significant difference in BPAR within six months (7[12.5%] vs. 9[6.7%], p=0.250, respectively). One patient taking PPI was diagnosed with graft failure. Infectious adverse events were not significantly different between the groups. Grade Ⅱ thrombocytopenia was more common in the PPI group (5[8.9%] vs. 2[1.5%], p=0.024, respectively). Conclusion : PPI prophylaxis after kidney transplantation was associated with acute rejection and severe thrombocytopenia. Further studies are needed to investigate the association between PPI and other complications.

Abstract

Background : Proton pump inhibitors (PPIs) are often prescribed after kidney transplantation to prevent gastrointestinal complications despite the lack of evidence. There are conflicting opinions reporting on an association between PPI prophylaxis and acute rejection. Additionally, several studies have reported increased risk of infections and hematological events of PPI use. The purpose of this study was to investigate risks of PPI prophylaxis early after kidney transplantation. Methods : We retrospectively analyzed the records of patients who received kidney transplantations September 2016-February 2018 using standard immunosuppressive regimens. The endpoints were to compare the incidence of adverse events, biopsy-proven acute rejection (BPAR), and graft failure within three months and six months after transplantation. Results : A total of 190 recipients were included in this study; of which 56 were included in the PPI group and 134 were included in the no-PPI group. Seven (12.5%) patients in the PPI group and five (3.7%) patients in the no-PPI group developed BPAR within three months, which was statistically significant (p=0.044). There was no significant difference in BPAR within six months (7[12.5%] vs. 9[6.7%], p=0.250, respectively). One patient taking PPI was diagnosed with graft failure. Infectious adverse events were not significantly different between the groups. Grade Ⅱ thrombocytopenia was more common in the PPI group (5[8.9%] vs. 2[1.5%], p=0.024, respectively). Conclusion : PPI prophylaxis after kidney transplantation was associated with acute rejection and severe thrombocytopenia. Further studies are needed to investigate the association between PPI and other complications.

참고문헌 (37)

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