Proton Pump Inhibitors and Adverse Effects in Kidney Transplant Recipients: A Meta-analysis

Overview

Journal World J Transplant

Publisher Baishideng Publishing Group

Specialty General Surgery

Date 2019 Aug 1

PMID 31363460

Citations 7

Authors

Boonphiphop Boonpheng

Charat Thongprayoon

Tarun Bathini

Konika Sharma

Michael A Mao

Wisit Cheungpasitporn

Affiliations

Soon will be listed here.

Abstract

Background: The adverse renal effects of proton pump inhibitors (PPIs) are increasingly recognized in both the general population and patients with chronic kidney disease. Several pharmacokinetic studies have also raised concerns regarding the interaction between PPIs and immunosuppressive drugs in transplant patients. Whether the adverse effects of PPIs have a clinical significance in kidney transplant recipients remains unclear. We performed this meta-analysis to assess the risk of adverse effects in kidney transplant recipients on PPI compared with those without PPI exposure.

Aim: To investigate the risk of acute rejection, graft loss, hypomagnesemia, renal dysfunction, and overall mortality in kidney transplant recipients on PPI compared with those without PPI exposure.

Methods: A systematic review was conducted in MEDLINE, EMBASE, and Cochrane databases from inception through October 2018 to identify studies that evaluated the adverse effects of PPIs in kidney transplant recipients, including biopsy-proven acute rejection, graft loss, hypomagnesemia, renal function, and overall mortality. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO, No. CRD42018115676.

Results: Fourteen observational studies with 6786 kidney transplant recipients were enrolled. No significant association was found between PPI exposure and the risk of biopsy-proven acute rejection at ≥ 1 year [pooled odds ratio (OR), 1.25; 95% confidence interval (CI), 0.82-1.91, = 55%], graft loss at 1 year (pooled OR = 1.30, 95%CI: 0.75-2.24, = 0%) or 1-year mortality (pooled OR = 1.53, 95%CI: 0.90-2.58, = 34%). However, PPI exposure was significantly associated with hypomagnesemia (pooled OR = 1.56, 95%CI: 1.19-2.05, = 27%). Funnel plots and Egger regression asymmetry test were performed and showed no publication bias.

Conclusion: PPI use was not associated with significant risks of higher acute rejection, graft loss, or 1-year mortality. However, the risk of hypomagnesemia was significantly increased with PPI use. Thus, future studies are needed to assess the impact of PPIs on long-term outcomes.

Citing Articles

COVID-19 among kidney transplant recipients: evaluating risk factors during the initial phase of the pandemic.

Nowak A, Caldinelli A, Segelmark M, Rydell H, Artborg A, Bellocco R Clin Kidney J. 2025; 18(3):sfaf030.

PMID: 40052164 PMC: 11883224. DOI: 10.1093/ckj/sfaf030.

Pharmacomicrobiomics: Immunosuppressive Drugs and Microbiome Interactions in Transplantation.

Mohamed M, Saqr A, Staley C, Onyeaghala G, Teigen L, Dorr C Transplantation. 2024; 108(9):1895-1910.

PMID: 38361239 PMC: 11327386. DOI: 10.1097/TP.0000000000004926.

Proton Pump Inhibitors Use in Kidney Transplant Recipients: A Population-Based Study.

Kiberd J, Quinn R, Ravani P, Lentine K, Clarke A, Jeong R Can J Kidney Health Dis. 2024; 11:20543581241228723.

PMID: 38356921 PMC: 10865938. DOI: 10.1177/20543581241228723.

Long-term Effects of Gastric Acid Prophylaxis in Kidney Transplant Recipients.

Yazici H, Oto O, Mirioglu S, Dirim A, Demir E, Uludag O Rev Nefrol Dial Transpl. 2023; 43(3):156-166.

PMID: 37794855 PMC: 10548784.

Incidence, Pathogenesis, and Management of Proton Pump Inhibitor-Induced Nephrotoxicity.

Wei X, Yu J, Xu Z, Wang C, Wu Y Drug Saf. 2022; 45(7):703-712.

PMID: 35641849 DOI: 10.1007/s40264-022-01181-4.

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