Use of Upper Endoscopy in Solid Organ Transplant Recipients to Determine Utility as a Pretransplant Procedure: 138

Introduction: Gastrointestinal bleeding (GIB) from gastro-duodenal ulcerations have been commonly observed in patients receiving solid organ transplantation. Several factors have been postulated, including the use of immunosuppressive medications such as steroids. Some centers have opted for pre-transplant upper gastrointestinal evaluations to predict these complications. However, there have been no outcome studies assessing a large number of patients undergoing various solid organ transplantations. Aim: To determine the frequency of upper endoscopy performed in post-transplant patients and report the frequency of GIB. Methods: We reviewed the charts of all patients who underwent solid organ transplant (kidney, liver, lung or heart) from 2009-2013 at a single transplant center. Data for up to 1 year post-transplant was reviewed. Patients were excluded if they died within 48 hours of transplant or had no follow-up. Results: Two hundred forty-three patients were identified who underwent solid organ transplantations. Twenty-one patients were excluded for lack of follow-up or early mortality. For the 222 patients included, the mean age was 57.0 years with a 72.5% male predominance. Mean length of follow-up was 335 days. The organs of transplant were: 31.1% liver, 28.8% kidney, 27.9% lung, 9.5% heart, and 2.7% heart-lung. Among this population, 94.6% were taking steroids, 48.2% were taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin, 12.2% were taking anti-coagulants, and 6.8% were on a combination of both. 11.3% of patients had thrombocytopenia (platelets <100). 68.5% were on a proton-pump inhibitor [PPI] and 13.1% on H2 receptor antagonists (H2RA). Of the 16/222 (7.2%) patients requiring an upper endoscopy, only 3 (1.4%) were performed for overt GIB. None of the three patients with GIB had thrombocytopenia or coagulopathy. Two with GIB were on aspirin, NSAIDs, and prednisone, and 1 was not on either PPI or H2RA. Conclusion: Clinically significant GIB in the 1-year post-transplant was seen in only 1.4% of the recipients. While many of the recipients were on acid suppression medication, these patients did have multiple risk factors for upper GIB, including the use of steroids, NSAIDs, and anti-coagulants. Despite these high-risk states, the incidence of GIB remains low. This study does not support the need for routine pre-transplant upper endoscopy.