Diarrhea in renal transplant recipients – Retrospective observational study from a center in South India

Abstract

Context: Diarrhea is one of the important causes of morbidity and graft dysfunction in renal transplant recipients. Aims: We aimed to study the risk factors and causes of diarrhea in renal transplant recipients and to assess the impact of diarrhea on graft function. Settings and Design: This was a retrospective observational study. Materials and Methods: A retrospective analysis of 912 renal allograft recipient records who underwent renal transplantation between January 2006 and June 2019 was performed. Patients with severe diarrhea requiring hospitalization were included. Investigations like stool microscopy including modified acid-fast stain and stool culture were performed. Statistical Analysis Used: Mean was calculated for normally distributed variables and median for not-normally distributed parameters. P < 0.05 was considered statistically significant. Univariate analysis was done to assess risk factors for diarrhea. Results: There were a total of 618 diarrheal episodes in 149 (16.3%) patients. Significant risk factors were deceased donor renal transplantation (58 [39%]) (P = 0.00024), the use of induction immunosuppression (44 [29.5%]) (P = 0.0002), and antirejection therapy (ART) (60 [40.3%]) (P = 0.0034). Infectious cause was identified in 85 (57%) patients, and cytomegalovirus was the predominant agent. Entamoeba histolytica (16 [10.7%]) was the predominant protozoal etiology. Temporary graft dysfunction during diarrheal episode occurred in 67 (45%) patients. Conclusions: Diarrhea occurred in 16.3% of renal transplant recipients. Deceased donor source, the use of induction immunosuppression, and ART were significant risk factors. Infectious cause was identified in 57% of diarrheal episodes. Following diarrhea, permanent graft dysfunction occurred in 10.7% of patients.