Gastrointestinal complications after kidney transplantation

Table 1 Clinical and histological characteristics of inflammatory bowel diseases in kidney transplantation

Disease	Clinical symptoms	Laboratory findings	Endoscopic findings	Histological findings	Treatment
Graft versus host disease	Diarrhoea, cutaneous rash	Non-specific	Oedema, erythema	High number of apoptotic cells, neuroendocrine cell proliferation	Corticosteroids reduction of immunosuppression
CMV colitis	Diarrhoea, abdominal pain, malaise, fever	Leukopenia, high level of transaminases, high PCR CMV-DNA viremia	Patchy erythema, exudates, microerosions, multiple erosions	Enterocyte apoptosis, inclusion bodies, detection of CMV on immunochemistry	Reduction of MMF, endovenous ganciclovir, oral valganciclovir foscarnet, cidofovir
MMF colitis	Diarrhoea, abdominal pain	Leukopenia	Erythema, erosions and ulcers; half of patients have normal macroscopic findings	Crypt cell apoptosis, atrophy of the crypt, crypt abscesses with eosinophil infiltrates, focal cryptitis, ulcerations and erosions	Reduction of MMF, discontinuation of MMF in severe forms
De novo IBD	Bloody diarrhoea, abdominal pain, intestinal subocclusive crisis	Elevated C-reactive protein	Patchy colitis, left-sided limited disease, pancolitis (UC), ileitis with multiple ulcers (CD)	Severe chronic inflammation with cryptitis and CD	Corticosteroids (effective), tacrolimus (low efficacy), cyclosporine (no efficacy), azathioprine (low efficacy), mesalazine/sulfasalazine (high efficacy), infliximab (limited experience)

CMV: Cytomegalovirus; PCR: Polymerase chain reaction; DNA: Deoxyribonucleic acid; MMF: Mycophenolate mofetil; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn’s disease.