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    -  Patil A D
    -  Saxena N G
    -  Thakare S B
    -  Pajai A E
    -  Bajpai D
    -  Jamale T E
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Diarrhea after kidney transplantation: A study of risk factors and outcomes

 Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Date of Submission29-Jul-2022
Date of Decision05-Jan-2023
Date of Acceptance07-Jun-2023
Date of Web Publication05-Sep-2023

Correspondence Address:
AD Patil,
Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpgm.jpgm_601_22

PMID: 37675667

 :: Abstract 

Background: Diarrhea in kidney transplant recipients (KTRs) can be associated with significant morbidity.
Material and Methods: We evaluated 198 KTRs for a history of diarrhea post-kidney transplant at a tertiary care center in western India over 1 year. A protocol-based evaluation of diarrhea was done with respect to clinical features, diagnostic evaluation, associated acute allograft dysfunction, and its impact on long-term allograft function. Primary outcomes of interest were: chronic allograft injury (CAI) and the need for mycophenolate mofetil (MMF) withdrawal. We also assessed the effect of MMF withdrawal on the risk of the development of CAI.
Results: Eighty-five of 198 (42.5%) recipients experienced diarrhea and a total of 140 diarrheal episodes were evaluated. The mean age of these 85 recipients was 38 ± 12 years and 72 (84.7%) were males. 73 of 85 recipients were on MMF at the time of diarrhea and in 35 (48%) of them MMF withdrawal was needed for chronic and persistent symptoms. Diarrhea was attributed to infective etiologies in 90 of 140 (64.2%) cases. Among the microbiologically confirmed infective diarrheal episodes, giardia and cryptosporidium were the common pathogens in 11/28 (39%) and 6/28 (21.4%) episodes respectively. One hundred and twenty-eight episodes out of 140 (91.4%) episodes were complicated by acute allograft dysfunction. Forty-one of 85 recipients (48.2%) developed chronic allograft injury and 12 (14.1%) developed allograft rejection (acute and/or chronic). Probability of chronic allograft injury was higher in those with MMF withdrawal.
Conclusion: Diarrhea post-kidney transplant adversely affects graft function, especially after MMF withdrawal.

Keywords: Chronic allograft injury, diarrhea, MMF withdrawal, kidney transplant, tacrolimus toxicity

How to cite this URL:
Patil A D, Saxena N G, Thakare S B, Pajai A E, Bajpai D, Jamale T E. Diarrhea after kidney transplantation: A study of risk factors and outcomes. J Postgrad Med [Epub ahead of print] [cited 2023 Sep 26]. Available from:



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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow