Prophylactic Gastric Operations in Uremic Patients Prior to Renal Transplantation

Gastroduodenal 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.