Persistent Infectious Diarrhea as a Risk Factor for Deterioration of Renal Function in Kidney Transplant Recipients

Abstract

Background: Gastrointestinal complications are common in kidney transplant recipients. Severe diarrhea might result in graft dysfunction or rejection if being ignored. The study aim was to describe the relationship between kidney allograft function and diarrhea, and to determine how diarrhea is influenced by various immunosuppressive regimens at a single center in Taiwan.Methods: This was a retrospective and comparative study. We included kidney transplant recipients who suffered from persistent diarrhea between January 2009 and August 2015. Survival and regression analyses and sub-analyses of creatinine levels over different diarrhea periods were performed.Results: We eventually collected 62 patients for analyses, including 16 with infectious diarrhea and 46 with non-infectious diarrhea. At 3rd year post transplantation, patients with infectious diarrhea demonstrated a significantly lower cumulative renal function rate (56.3% vs. 84.7%, p<0.05). No significant differences were found between recipients receiving different immunosuppressive regimens in terms of renal function. However, recipients receiving mammalian target of rapamycin (mTOR) inhibitor and mycophenolate mofetil (MMF) tended to show a slower rate for deterioration of renal function.Conclusion: In this study, infectious diarrhea, especially when persisting for more than 10.5 days, does significant damages to renal function and predicts for deterioration of renal function. Besides, regimen of mTOR inhibitor and MMF showed a trend toward reducing incidence of deterioration of renal function. Better understanding of the diarrhea etiologies to provide timely treatment for this illness and appropriate choice of immunosuppressive regimen might help maintain renal function for kidney transplant recipients.