Prophylactic gastric operations in uremic patients prior to renal transplantation

Abstract

AbstractGastroduodenal bleeding or perforation occurs in 3.5–60% of renal transplant patients. The mortality rate of this complication ranges from 35 to 75%. Experience with 61 chronic hemodialysis patients being prepared for renal transplantation is presented. History, endoscopy, and gastric analysis disclosed a considerable risk of gastroduodenal complications in 20 transplant candidates, defined as a history, presence, or sequelae of ulcer disease or hyperchlorhydria. These 20 patients underwent prophylactic gastric surgery. Lower risk patients were treated by selective proximal vagotomy, and higher risk patients underwent a selective gastric vagotomy plus Billroth I gastric resection. Follow‐up for 11–34 months showed no mortality and no gastroduodenal symptomatology. A kidney transplant has been performed to date in 15 of the patients who had prophylactic gastric surgery, and none of them developed gastroduodenal complications during follow‐up of 6–30 months after transplantation. Of 29 patients who were not believed to be at risk for gastroduodenal complications and did not have prophylactic gastric surgery, 3 bled from duodenal ulcers after renal transplantation, 1 with fatal outcome.