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      Gastrointestinal complications after kidney transplantation

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          Abstract

          Gastrointestinal complications are common after renal transplantation, and they have a wide clinical spectrum, varying from diarrhoea to post-transplant inflammatory bowel disease (IBD). Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. Drug-related colitis are the most frequently encountered colitis after kidney transplantation, particularly those related to the chronic use of mycophenolate mofetil, while de novo IBDs are quite rare. This review will explore colitis after kidney transplantation, with a particular focus on different clinical and histological features, attempting to clearly identify the right treatment, thereby improving the final outcome of patients.

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          Most cited references97

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          Inflammatory bowel disease.

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            International consensus guidelines on the management of cytomegalovirus in solid organ transplantation.

            Cytomegalovirus (CMV) remains one of the most common infections after solid organ transplantation, resulting in significant morbidity, graft loss, and occasional mortality. Management of CMV varies considerably among transplant centers. A panel of experts on CMV and solid organ transplant was convened by The Infectious Diseases Section of The Transplantation Society to develop evidence and expert opinion-based consensus guidelines on CMV management including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues.
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              American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation.

              In recent years, major progress has been made in the development, investigation and clinical application of novel immunosuppressive drug therapies to prevent acute rejection. Critical to the ultimate clinical application of new drug therapies is the ongoing performance of large multi-center clinical trials. However, there has been a paucity of infectious disease monitoring built into these protocols. Given that infectious complications are a major source of morbidity and mortality in transplant recipients, the assessment of the magnitude of risk of infection associated with a given immunosuppressive strategy may be as important as the assessment of rejection. For the above reasons, screening, monitoring and reporting recommendations for common transplant-associated infections were developed for use in clinical trials evaluating immunosuppressive strategies. These recommendations have two major goals: (i) to provide clinically relevant definitions for tracking infectious complications occurring in participants in immunosuppressive trials and (ii) where appropriate, to recommend specific laboratory monitoring and surveillance methods.
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                Author and article information

                Contributors
                Journal
                World J Gastroenterol
                World J Gastroenterol
                WJG
                World Journal of Gastroenterology
                Baishideng Publishing Group Inc
                1007-9327
                2219-2840
                14 October 2020
                14 October 2020
                : 26
                : 38
                : 5797-5811
                Affiliations
                General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
                Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
                Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
                Pathology Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania 95123, Italy
                Gastroenterology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania 95100, Italy
                General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
                General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
                General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
                Organ Transplant Unit, University Hospital of Catania, Catania 95123, Italy
                General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Catania 95123, Italy
                Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania 95123, Italy. veroux@ 123456unict.it
                Author notes

                Author contributions: Gioco R, Corona D and Veroux M wrote the paper; Pinto F, Schipa C, and Privitera F collected the data; Ekser B, Puzzo L, Inserra G, Veroux P, and Veroux M revised the paper.

                Supported by FIR 2014 Project, University of Catania.

                Corresponding author: Massimiliano Veroux, MD, PhD, Associate Professor, Surgeon, General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, Catania 95123, Italy. veroux@ 123456unict.it

                Article
                jWJG.v26.i38.pg5797
                10.3748/wjg.v26.i38.5797
                7579754
                33132635
                dd164d54-181a-422a-8893-d3a98e4f1e8d
                ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 28 April 2020
                : 28 May 2020
                : 25 August 2020
                Categories
                Minireviews

                inflammatory bowel disease,kidney transplantation,solid organ transplantation,crohn disease,ulcerative colitis,mycophenolate mofetil colitis,mycophenolate mofetil,colitis,cytomegalovirus

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