Comparing safety of proton‐pump inhibitors versus H2‐receptor antagonists in kidney transplant recipients: A systematic review and meta‐analysis
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…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,844 participants or records.
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