Comparison of Histamine Receptor Antagonists Versus Proton Pump Inhibitor Stress Ulcer Prophylaxis in Kidney Transplant Recipients, A
Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT
Department of Pharmacy, Columbia University Medical Center, New York, NY
School of Pharmacy, University of Missouri- Kansas City, Kansas City, MO
Meeting: 2013 American Transplant Congress
Abstract number: D1762
Purpose: Histamine-2 receptor antagonists (H2RA) or proton pump inhibitors (PPI) are often utilized for stress ulcer prophylaxis in kidney transplant (KTx) recipients. The purpose of this study was to examine and compare the incidence of adverse events in KTx recipients who were receiving stress ulcer prophylaxis with H2RAs or PPIs.
Methods: This retrospective study included all KTx recipients from three transplant centers who were transplanted in 2009 through 2011. The primary objective was to compare the incidence of stress ulcer development and upper gastrointestinal bleeding (GIB) events within the first year of transplantation for patients receiving H2RA or PPI. Secondary outcomes included total infections, pneumonia, Clostridium difficile, hip fractures, cytomegalovirus, organ rejection, and bacteremia. Patients were excluded if they received H2RAs or PPIs prior to KTx with documented medical indications, such as acid reflux or peptic ulcer disease. Baseline demographic data were collected for both groups. This study was approved by each center's Institutional Review Board.
Results:
| Prophylaxis with H2RA | Prophylaxis with PPI | p-value | |
| Total | 177 | 35 | |
| Incidence of hip fracture within 1 year post-transplant | 0 | 0 | |
| Incidence of pneumonia within 1 year post-transplant | 3 | 1 | 0.65 |
| Incidence of Clostridium difficile within 1 year post-transplant | 2 | 2 | 0.28 |
| Incidence of gastrointestinal bleeding within 1 year post-transplant | 1 | 0 | 0.66 |
| Incidence of rejection with 1 year post-transplant | 26 | 5 | 0.96 |
| Incidence of CMV within 1 year post-transplant | 17 | 1 | 0.38 |
| Incidence of bacteremia within 1 year post-transplant | 7 | 1 | 0.76 |
| Average tacrolimus dose 12 months post-transplant (ng/mL) | 7.3 | 6.4 | 0.58 |
| Average mycophenolate equivalent dose 12 months post-transplant (mg) | 1307 | 1208 | 0.40 |
| Average prednisone dose 12 months post-transplant (mg) | 4.5 | 3.0 | 0.0085 |
Conclusion: H2RAs and PPIs are effective at preventing stress ulcer and upper GIB after KTx. There are similar rates of adverse events when comparing H2RAs and PPIs. Additional studies are needed to confirm this finding.
To cite this abstract in AMA style:
Morris G, Hardinger K, Tsapepas D, Tichy E. Comparison of Histamine Receptor Antagonists Versus Proton Pump Inhibitor Stress Ulcer Prophylaxis in Kidney Transplant Recipients, A [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/comparison-of-histamine-receptor-antagonists-versus-proton-pump-inhibitor-stress-ulcer-prophylaxis-in-kidney-transplant-recipients-a/. Accessed May 14, 2025.« Back to 2013 American Transplant Congress