|Ahead of print
Diarrhea after kidney transplantation: A study of risk factors and outcomes
AD Patil, NG Saxena, SB Thakare, AE Pajai, D Bajpai, TE Jamale
Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
|Date of Submission||29-Jul-2022|
|Date of Decision||05-Jan-2023|
|Date of Acceptance||07-Jun-2023|
|Date of Web Publication||05-Sep-2023|
Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
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: https://www.jpgmonline.com/preprintarticle.asp?id=385186