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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 22  |  Issue : 6  |  Page : 1115-1120
Association of Helicobacter pylori IgG antibody with various demographic and biochemical parameters in kidney transplant recipients


1 Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Internal Medicine, Shahrekord University of Medical Sciences, Hajar Medical, Educational and Therapeutic Center, Shahrekord, Iran

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Date of Web Publication8-Nov-2011
 

   Abstract 

Few reports are available regarding the promoting factors that affect Helicobacter pylori (H. pylori) infection in renal transplant (RTx) patients. We report a cross-sectional study that was conducted on a group of stable RTx patients to investigate the relationship of various demographic and biochemical parameters of these patients with serum H. pylori IgG antibody titer as a sign of H. pylori infection. A total of 72 patients who were referred to the clinic for continuing their treatment were enrolled in this study. These patients included 47 males and 25 females. The mean age of the study patients was 44 (±12) years. The mean length of time after they received a transplanted kidney was 67.5 (±42) months (median: 62 months). The mean value of serum H. pylori-specific IgG antibody titer among these patients was 3 (±4.6) U/mL (median: 1 U/mL), and that of intact parathormone (iPTH) was 18.4 (±8.2) pg/mL (median: 16.5 pg/mL). The mean serum magnesium (Mg) was 1.9 (±0.20) mg/dL (median: 1.9 mg/dL) and the mean creatinine clearance was 53 (±11) mL/min (median: 56 mL/min). In this study population, there was no significant difference in the H. pylori IgG antibody titers, serum iPTH, Mg, calcium, alkaline phosphatase and albumin levels as well as body mass index (BMI) between males and females or diabetics and non-diabetics. There was no significant relationship between serum H. pylori IgG antibody titers and the age of the patients, BMI, serum Alb, phosphorus, Ca, serum leptin and serum ALP. Significant negative correlation between serum H. pylori IgG antibody titers and serum Mg (r = -0.30, P = 0.01) and serum iPTH (r = -0.25, P = 0.03) was seen. A significant positive correlation was found between serum H. pylori IgG antibody titer and creatinine clearance (r = 0.26, P = 0.02), and a near-significant positive correlation was found with the duration of RTx (r = 0.20, P = 0.08). Our study shows that the correlation of H. pylori IgG antibody titer with some demographic and biochemical indices in RTx recipients may be different from what has been reported in hemodialysis patients. Larger clinical studies are needed to assess the clinical implications of our findings.

How to cite this article:
Baradaran A, Nasri H. Association of Helicobacter pylori IgG antibody with various demographic and biochemical parameters in kidney transplant recipients. Saudi J Kidney Dis Transpl 2011;22:1115-20

How to cite this URL:
Baradaran A, Nasri H. Association of Helicobacter pylori IgG antibody with various demographic and biochemical parameters in kidney transplant recipients. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Nov 12];22:1115-20. Available from: http://www.sjkdt.org/text.asp?2011/22/6/1115/87202

   Introduction Top


Helicobacter pylori (H. pylori) is a major etiologic factor in gastric complications and gastroduodenal ulceration. [1],[2],[3],[4],[5],[6] Studies have also demonstrated an association between H. pylori and gastric cancer. [7] Upper gastrointestinal problems are not uncommon in renal transplant (RTx) recipients, and the mortality due to upper gastrointestinal hemorrhage may reach up to 29%. [8] It has now been found that H. pylori is one of the co-factors involved in the development of neoplastic transformation of gastric mucosa. [9],[10] A particular gastric lymphoma called mucosa-associated lymphoid tissue lymphoma may develop in RTx recipients. It generally responds to the eradication of this bacteria. [11] Few reports are available regarding the promoting factors that affect H. pylori infection in RTx patients. According to the previously mentioned data concerning the importance of H. pylori infection in RTx patients, we aimed to investigate the relationship of various demographic and biochemical parameters of RTx patients with serum H. pylori IgG antibody titers as a sign of H. pylori infection.


   Materials and Methods Top


Patients

This cross-sectional study was conducted on a group of stable RTx patients who were referred to the nephrology clinic of our institution for continuing their treatment. These patients were recruited between January and September 2006. The study was carried out in the Hajar Medical Educational and Therapeutic Centre of the Shahrekord University of Medical Sciences of Iran. All patients signed the consent form for participation in this study. Exclusion criteria included the presence of acute rejection, any active or chronic infection, intake of antibiotics during the past two months and taking drugs that interfere with gastric acid production and function during the past two months, such as non-steroidal anti-inflammatory drugs, antacids, proton pump inhibitors and H 2 receptor antagonists.

After admission, all patients were examined and their medical history, including the length of time since they underwent kidney transplantation, and their treatment protocols were obtained. Patients were also examined for blood pressure (BP) and body mass index (BMI); BMI was calculated using the standard formula (weight in kilograms/height in square meters). The basic immunosuppressive regimen of the recipients consisted of a combination of cyclosporine at a mean dose of 190 ± 60 mg/d (median: 200 mg/d) and prednisolone 7.5 mg/d for all patients and mycophenolate mofetil in 46% of the patients at a dose of 1500 ± 500 mg/d (median: 1500 mg/d) or azathioprine at a dose of 50 mg/d to 100 mg/d in 26% of the patients.

Laboratory methods

Serum H. pylori-specific IgG antibody titer (titer >10 U/mL was interpreted as positive according to the manufacturer's instructions) was measured as follows: blood samples were drawn after an overnight fast and were centrifuged within 15 minutes of drawing.

The levels were measured by the enzyme-linked immunosorbent assay (ELISA) method using a standard kit. Intact parathormone (iPTH) was measured by radio immunoassay (RIA) using DSL-8000 kits from the USA (normal range of values is 10 pg/mL to 65 pg/mL). Serum leptin (normal range of values for males is 3.84 (±1.79) and for females is 7.36 (±3.73) ng/mL) was measured by the ELISA method using DRG kits, Germany.

Also, peripheral venous blood samples were collected for biochemical analysis, including serum creatinine (creat), blood urea nitrogen (BUN), albumin (Alb), serum magnesium (Mg), phosphorus (P), calcium (Ca) and alkaline phosphatase (ALP), using standard kits after an over-night fast. Creatinine clearance (CrcL) was calculated from creat, age and body weight. [12]


   Statistical Analysis Top


The results are expressed as mean ± SD and median values. Statistical correlation was assessed using the partial correlation test. Comparison between groups was made using the student's "t" test.

For normalization of the iPTH data, its logarithms of 10 were used. All statistical analyses were performed with the SPSS statistical package (version 11.500 for Windows; SPSS, Chicago, IL, USA). Statistical significance was determined at a P-value of <0.05.


   Results Top


A total of 72 patients were enrolled in this study, including 47 males and 25 females; 11 of the study patients had diabetes mellitus. The mean age of the patients was 44 (±12) years. The mean length of time since they received a transplanted kidney was 67.5 (±42) months (median: 62 months). [Table 1] shows the demographic and biochemical data of the patients. The mean BMI of the patients was 44 (±12.5) kg/m 2 , the mean serum Mg was 1.9 (±0.20) mg/dL (median: 1.9 mg/dL) and the mean creatinine clearance was 53 (±11) mL/min (median: 56 mL/min).
Table 1: Demographic and biochemical data of the study patients.

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The mean value of serum H. pylori-specific IgG antibody titer was 3 (±4.6) U/mL (median 1 U/mL) and the mean serum iPTH was 18.4 (±8.2) pg/mL (median: 16.5 pg/mL). In this study population, there was no significant difference of H. pylori IgG antibody titers, serum iPTH, Mg, Ca, ALP, Alb and BMI between males and females or diabetics and non-diabetics. Also, there was no significant relationship between serum H. pylori IgG antibody titers and the age of the patients, BMI, serum Alb, P, Ca, serum leptin and serum ALP levels (P = NS).

Significant negative correlation was seen between serum H. pylori IgG antibody titer and serum Mg (r = -0.30, P = 0.01, [Figure 1]) and serum iPTH levels (r = -0.25, P = 0.03, [Figure 2]) (adjusted for creatinine clearance for both correlations). A significant positive correlation was found between serum H. pylori IgG antibody titers and creatinine clearance (r = 0.26, P = 0.02, [Figure 3]) (adjusted for duration of kidney transplantation and serum magnesium); also, a near-significant positive correlation was found between serum H. pylori IgG antibody titers and duration of renal transplantation (r = 0.20, P = 0.08).
Figure 1: Significant negative correlation of serum H. pylori IgG antibody titer and serum magnesium.

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Figure 2: Significant negative correlation of serum H. pylori IgG antibody titer and serum intact parathormone levels.

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Figure 3: Significant positive relation of serum H. pylori IgG antibody titer and creatinine clearance.

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   Discussion Top


In this study, we did not find any significant difference of H. pylori IgG antibody titer and the various biochemical parameters between males and females or diabetics and non-diabetics. Also, no significant relationship was found between serum H. pylori IgG antibody titers and the age of the patients, BMI and the various biochemical parameters. Significant negative correlation was found between serum H. pylori IgG antibody titer and serum Mg and serum iPTH levels. A significant positive relation was found between serum H. pylori IgG antibody titer and creatinine clearance; also, a near-significant positive correlation was found between serum H. pylori IgG antibody titer and duration of renal transplantation.

Upper gastrointestinal mucosal lesions are common in RTx recipients, with H. pylori being an important factor contributing to peptic ulcer disease. [13] Although some authors had reported a high prevalence of up to 80% of H. pylori colonization in RTx recipients, [13] recent data shows that the incidence of peptic ulcer is only 3%, [14] and that H. pylori infection seems to be less frequent in these patients than in the general population. [15],[16],[17] Indeed, the prevalence of H. pylori infection in renal transplant recipients is quite variable. Some authors have reported a high incidence of up to 80%. [18] This high incidence is supported by another recent review that showed that about 50% of transplant recipients had H. pylori infection found during endoscopy. [19] Potential reasons for the low prevalence reported in recent studies include spontaneous seroconversion of H. pylori in up to 29%, owing to long-standing immunosuppression. [15] Other contributing factors might include a defect in humoral immunity resulting in a decrease in antibody response caused by concurrent medications or the high urea concentration observed in RTx recipients. [16],[17]

There is little data regarding the impact of demographic and biochemical parameters in RTx recipients on H. pylori infection. We previously reported on the effect of serum Mg, parathomone, serum leptin and 25-hydroxy vitamin D levels on H. pylori infection in a group of hemodialysis (HD) patients. [20],[21],[22],[23] Because the situation of HD and RTx patients is quite different, we cannot extrapolate these results to RTx patients. In this study, the patients had a creatinine clearance of 53 (±11) mL/min (median: 56 mL/min), and the mean serum H. pylori IgG antibody titer was 3 (±4.6) U/mL (median: 1 U/mL). In our earlier study on HD patients in 2005, the serum H. pylori IgG antibody titer was 7.73 (±10.3) U/mL (median: 2 U/mL). [23] We showed a positive association of serum Mg, parathormone and 25-hydroxy vitamin D levels with H. pylori IgG antibody titer in HD patients. [20],[21],[22],[23] Secondary hyperparathyroidism is common in HD patients, [24],[25],[26],[27] and improves after renal transplantation along with recovered function of the renal allograft. [27] Successful kidney transplantation is believed to cure secondary hyperparathyroidism, but persistent disease has emerged in a significant number of allograft recipients. Parathyroidectomy is ultimately required in some of these patients. [27],[28] In the study conducted by Evenepoel et al on 1332 kidney allograft recipients transplanted between 1989 and 2000, 55 patients (4.1%) required parathyroidectomy after a first successful kidney transplantation because of persistent hyperparathyroidism. They concluded that persistent hyperparathyroidism requiring parathyroidectomy after successful kidney transplantation is a common clinical problem. [29]

In the present study, the results are different; the patient's mean iPTH was 18.4 (±8.2) pg/mL (median: 16.5 pg/mL), indicating that there was no secondary hyperparathyroidism. Hence, this study shows that the correlation of H. pylori IgG antibody titer with various demographic or biochemical indices of RTx recipients may be different in comparison with HD patients. In conclusion, the correlation of various demographic and biochemical indices with serum H. pylori IgG antibody titer can vary between HD and RTx patients. Studies on a larger number of patients are required to validate our observation.

 
   References Top

1.Owens ML, Passaro E, Wilson SE, et al. Treatment of peptic ulcer disease in renal transplant patient. Ann Surg 1977;186:17-21.  Back to cited text no. 1
    
2.Hosseini Asl MK, Nasri H. Prevalence of Helicobacter pylori infection in maintenance hemodialysis patients with non-ulcer dyspepsia. Saudi J Kidney Dis Transpl 2009;20(2):223-6.  Back to cited text no. 2
    
3.Nasri H. Close association between helicobacter pylori infection and serum homocysteine in stable hemodialysis patients. Adv Mol Med 2005;1(4):171-5.  Back to cited text no. 3
    
4.Nasri H. Aggravation of anemia by helicobacter pylori infection in maintenance hemodialysis patients. Pak J Nutr 2006;5(2):172-5.  Back to cited text no. 4
    
5.Nasri H. The association between helicobacter pylori infection and body mass index in hemodialysis patients. Acta Facultatis Medicae Naissensis 2006;23(3):129-33.  Back to cited text no. 5
    
6.Baradaran A. Nasri H. Helicobacter Pylori IgG Specific antibodies in association with serum albumin in maintenance hemodialysis patients. Pak J Nutr 2005;4(4):265-9.  Back to cited text no. 6
    
7.IARC Working group on the evaluation of the carcinogenic risks to humans. Helicobacter pylori. Schistosomes, Liver Flukes and Helicobacter Pylori; Views and Expert Opinions of an IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon IARC: 1994; 177-240.  Back to cited text no. 7
    
8.Meyers W, Harris N, Stein Sm, et al. Alimentary tract complications after renal transplantation. Ann Surg 1979;190:535-42.  Back to cited text no. 8
    
9.Benoit G, Moukarzel M, Verdelli G, et al. Gastrointestinal complications in renal transplantation. Transplant Int 1993;6:45-9.  Back to cited text no. 9
    
10.Parsonnet J, Friedman G, Vandersteen D, et al. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 1991;325:1127-31.  Back to cited text no. 10
    
11.Ponticelli C, Passerini P. Gastrointestinal complications in renal transplant recipients. Transpl Int 2005;18(6):643-50.  Back to cited text no. 11
    
12.Cockcroft DW, Gault MH. Prediction of creatinin clearance from serum creatinine. Nephron 1976;16:31-41.  Back to cited text no. 12
    
13.Mukhtar A, Malik TQ, Karkar A. Should all dialysis patients be screened and treated for Helicobacter pylori preemptively before renal transplant? Saudi J Kidney Dis Transpl 2006;17 (2):232-3.  Back to cited text no. 13
    
14.Weisdorf-Schindele S, Lake JR. Gastrointestinal complications of solid and hematopoietic cell transplantation. In: Feldman M, Friedman LS, Sleisenger MH, Scharschmidt BF (eds). Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 7 th Edn, Philadelphia, PA: WB Saunders; 2002; 473-86.  Back to cited text no. 14
    
15.Sarkio S, Rautelin H, Halme L. The course of Helicobacter pylori infection in kidney transplantation patients. Scand J Gastroenterol 2003; 38(1):20-6  Back to cited text no. 15
    
16.Korzonek M, Szymaniak L, GiedrysKalemba S, Ciechanowski K. Is it necessary to treat Helicobacter pylori infection in patients with endstage renal failure and in renal transplant recipients? Pol Arch Med Wewn 2004;111(3):297-304.  Back to cited text no. 16
    
17.Yildiz A, Besisik F, Akkaya V, et al. Helicobacter pylori antibodies in hemodialysis patients and renal transplant recipients. Clin Transplant 1999; 13(1 Pt 1):13-6.  Back to cited text no. 17
    
18.Hruby Z, Myszka-Bijak K, Gosciniak G, et al. Helicobacter pylori in kidney allograft recipients: high prevalence of colonization and low incidence of active inflammatory lesions. Nephron 1997;75(1):25-9.  Back to cited text no. 18
    
19.Teenan RP, Burgoyne M, Brown IL, et al. Helicobacter pylori in renal transplant recipients. Transplantation 1993;56:L56L100.  Back to cited text no. 19
    
20.Nasri H. Helicobacter pylori infection and its relationship to plasma magnesium in hemodialysis patients. Bratisl Lek Listy 2007;108 (12):506-9.  Back to cited text no. 20
    
21.Nasri H. Baradaran A. The influence of serum 25-hydroxy vitamin D levels on Helicobacter Pylori Infections in patients with end-stage renal failure on regular hemodialysis. Saudi J Kidney Dis Transpl 2007;18(2):215-9.  Back to cited text no. 21
    
22.Baradaran A. Nasri H. Helicobacter pylori IgG antibodies in association with secondary hyperparathyroidism in end-stage renal failure patients undergoing regular hemodialysis. Arch Med Sci 2005;1(3):148-51.  Back to cited text no. 22
    
23.Baradaran A. Nasri H. Correlation of serum leptin with circulating antihelico bacter pylori IgG antibodies in end-stage renal failure patients on regular hemodialysis. Pak J Nutr 2005; 4(6):389-92.  Back to cited text no. 23
    
24.Horl WH. Secondary hyperparathyroidism: present and future therapeutic implications. Nephrol Dial Transplant 2002;17(5):732-3.  Back to cited text no. 24
    
25.Nasri H, Baradaran A. Long-lasting advanced primary hyperparathyroidism associated with endstage renal failure in a diabetic patients. Acta Med Iran 2004;42(6):461-6.  Back to cited text no. 25
    
26.Nasri H. Effects of diabetes mellitus, age and duration of dialysis on parathyroid gland function in end-stage renal-failure patients undergoing regular hemodialysis. Saudi J Kidney Dis Transpl 2008;19:608-13 .  Back to cited text no. 26
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27.Nasri H, Baradaran A, Naderi AS. Close association between parathyroid hormone and left ventricular function and structure in end-stage renal failure patients under maintenance hemodialysis. Acta Med Aust 2004;31(3):67-72.  Back to cited text no. 27
    
28.Uchida K, Tominaga Y, Tanaka Y, Takagi H. Renal transplantation and secondary hyperparathyroidism. Semin Surg Oncol 1997;13(2):97-103.  Back to cited text no. 28
    
29.Evenepoel P, Kuypers D, Maes B, Messiaen T, Vanrenterghem Y. Persistent hyperparathyroidism after kidney transplantation requiring parathyroidectomy. Acta Otorhinolaryngol Belg 2001; 55(2):177-86.  Back to cited text no. 29
    

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Correspondence Address:
Hamid Nasri
Department of Internal Medicine, Shahrekord University of Medical Sciences, Hajar Medical, Educational and Therapeutic Center, Shahrekord
Iran
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PMID: 22089767

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