Comparing Safety of Proton-Pump Inhibitors Versus H2-Receptor Antagonists in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis Publisher Pubmed



Mohammadi K¹ ; Yaribash S² ; Razi B³ ; Dashtikhavidaki S¹ Show Affiliations
Source: Journal of Clinical Pharmacy and Therapeutics Published:2022

Abstract

What is known and objective: Multiple studies have been conducted to compare the safety of proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs) as acid-suppressive treatment in kidney transplant recipients with conflicting results. This systematic review and meta-analysis aimed to evaluate the risk of adverse effects in kidney transplant patients receiving PPIs compared to those treated with H2RAs. Methods: A systematic search was performed on the databases from inception to June 2021. The treatment effects were expressed as odds ratio (OR), weighted mean differences (WMD) and their 95% confidence intervals (CI) and pooled by a random-effects model. Results and Discussions: Eight studies, consisting 4,844 patients, were included. Patients were followed for a mean duration of 23.57 months after transplantation. Compared with H2RAs, PPIs exposure was associated with similar rate of biopsy-proven acute rejection (BPAR) (OR = 1.05, 95% CI 0.83–1.34, p = 0.67), mortality (OR = 1.31, 95% CI 0.56–3.07, p = 0.533), graft loss (OR = 1.06, 95% CI 0.59–1.93, p = 0.842), Clostridioides difficile infection (OR = 1.37, 95% CI 0.49–3.85, p = 0.545) and pneumonia (OR = 1.83, 95% CI 0.95–3.52, p = 0.072). The estimated glomerular filtration rate (eGFR) at 12 months was lower in patients who received PPIs than those treated with H2RAs (WMD = −1.01, 95% CI −1.89 to −0.12 ml/min/1.73m2, p = 0.02). The PPI-treated kidney transplant patients experienced higher rate of antibody-mediated rejection (AMR) (OR = 1.87, 95% CI 1.03–3.04, p = 0.039) and hypomagnesemia (OR = 2.16, 95% CI 1.46–3.20, p ˂ 0.001). What is new and Conclusions: Compared with H2RAs, PPIs were not associated with higher risks of BPAR, mortality, graft loss or infection-related outcomes. However, taking PPIs was associated with higher rates of AMR and hypomagnesemia, and lower eGFR at one year after transplantation. Further well-controlled studies are needed to assess the impact of acid-suppressive strategy on long-term outcomes in KTRs. © 2021 John Wiley & Sons Ltd.