Abstract: PO2503
Sevelamer-Associated Gastrointestinal Complications in Kidney Transplant Recipients
Session Information
- Transplant Complications: Cardiovascular, Metabolic, and Societal
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Hussain, Mohammad Ahraz, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Kwong, Stanley, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Yabu, Julie M., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Lum, Erik Lawrence, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Kendrick, Elizabeth A., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
Introduction
Sevelamer (SV) is a resin based oral phosphate binder used commonly in chronic kidney disease (CKD) patients. Clinical trials performed for approval for clinical use showed mild to moderate gastrointestinal (GI) intolerance in a minority of patients. In general clinical use of SV in CKD patients, there have been case reports of more serious GI problems than were reported in original trials, including GI bleeding and colonic complications including colitis and perforation. The majority of patients receiving kidney transplants have required long term oral phosphate binders at the time they are transplanted, often using SV. Delayed graft function (DGF) early post transplant may require ongoing use of oral phosphate binders to control hyperphosphatemia
Case Description
We report 3 cases of significant GI morbidity in association with SV occurring in transplant recipients within the first 2 weeks after kidney transplantation. In one patient, the post transplant course was complicated by sepsis due to perforated colonic diverticulum in the context of preexisting diverticular disease; surgical specimen showed SV crystals associated within the area of bowel perforation. Two patients had severe upper GI symptoms and abnormal findings on upper endoscopy, including severe esophagitis and esophageal ulceration. SV crystals were found in the biopsies of abnormal areas. Two patients had long-term use of SV prior to transplantation, whereas one patient was treated with SV for a short time only after transplantation. All had required more than one phosphate binder for long-term control of hyperphosphatemia; two required cinacalcet for management of secondary hyperparathyroidism.
Discussion
SV use may have more serious GI adverse effects in CKD patients than noted in the original clinical trials. Preexisting GI disease and/or abnormalities may increase the risk of adverse GI effects related to SV. Recent use of SV prior to kidney transplantation or use of SV for control of hyperphosphatemia in the context of DGF can be associated with GI morbidity in the early post transplant setting. Need for higher doses of phosphate binders and severity of hyperparathyroidism may be contributing factors to this risk.