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World J Gastroenterol. Oct 14, 2020; 26(38): 5797-5811
Published online Oct 14, 2020. doi: 10.3748/wjg.v26.i38.5797
Gastrointestinal complications after kidney transplantation
Rossella Gioco, Daniela Corona, Burcin Ekser, Lidia Puzzo, Gaetano Inserra, Flavia Pinto, Chiara Schipa, Francesca Privitera, Pierfrancesco Veroux, Massimiliano Veroux
Rossella Gioco, Flavia Pinto, Chiara Schipa, Francesca Privitera, General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
Daniela Corona, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
Burcin Ekser, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Lidia Puzzo, Pathology Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania 95123, Italy
Gaetano Inserra, Gastroenterology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania 95100, Italy
Pierfrancesco Veroux, Organ Transplant Unit, University Hospital of Catania, Catania 95123, Italy
Massimiliano Veroux, General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Catania 95123, Italy
Massimiliano Veroux, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania 95123, Italy
Author contributions: Gioco R, Corona D and Veroux M wrote the paper; Pinto F, Schipa C, and Privitera F collected the data; Ekser B, Puzzo L, Inserra G, Veroux P, and Veroux M revised the paper.
Supported by FIR 2014 Project, University of Catania.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Massimiliano Veroux, MD, PhD, Associate Professor, Surgeon, General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania 95123, Italy. veroux@unict.it
Received: April 28, 2020
Peer-review started: April 28, 2020
First decision: May 15, 2020
Revised: May 28, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: October 14, 2020
Abstract

Gastrointestinal complications are common after renal transplantation, and they have a wide clinical spectrum, varying from diarrhoea to post-transplant inflammatory bowel disease (IBD). Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. Drug-related colitis are the most frequently encountered colitis after kidney transplantation, particularly those related to the chronic use of mycophenolate mofetil, while de novo IBDs are quite rare. This review will explore colitis after kidney transplantation, with a particular focus on different clinical and histological features, attempting to clearly identify the right treatment, thereby improving the final outcome of patients.

Keywords: Inflammatory bowel disease, Kidney transplantation, Solid organ transplantation, Crohn disease, Ulcerative colitis, Mycophenolate mofetil colitis, Mycophenolate mofetil, Colitis, Cytomegalovirus

Core tip: Colitis is not common after kidney transplantation and may be related to post-transplant infection or chronic immunosuppression. Clinical and histological features may be completely different from those described in the general population. We herein discuss the epidemiology, clinical and histological features, and potential for treatment of post-transplant colitis in kidney transplantation.