Abstract
International Journal of Medicine and Public Health,2021,11,3,126-132.DOI:10.5530/ijmedph.2021.3.23Published:August 2021Type:Review articlePost Liver Transplantation Diarrhea: Etiology, Evaluation and TreatmentRicha Sinha, and Rahul Richa Sinha1, Rahul2,* 1Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, INDIA. 2Department of Surgical Gastroenterology, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, INDIA. Abstract:Diarrhea is a frequent post-operative complication following liver transplantation. It occurs frequently in the initial 3-4 months. Common etiologic factors include immunosuppressive drugs (Mycophenolate mofetil, Tacrolimus and Cyclosporine) and infection (Clostridium difficile, Cytomegalovirus and Rotavirus infection). Inflammatory bowel disease, malignancy and graft versus host disease are infrequent but important causes. Actual incidence of Diarrhea among liver transplant recipients remains elusive as it is often under-reported. However, as per the current literature, it occurs in 10-40 percent of recipients. It can result in dehydration, dyselectrolytemia, derangement of renal profile and even graft loss. The alteration in immunosuppressive drugs in early post-operative period may predispose graft rejection. High index of suspicion and systematic evaluation is pertinent for timely diagnosis. The review summarizes the important causes, epidemiology, recent updates, evaluation and management of the of post liver transplant diarrhea. Keywords:Diarrhea, Immunosuppression, infection, Liver transplantation, RejectionView:PDF (215.6 KB)
Highlights
Risk factors include: age, dose of immunosuppression, type of drugs used (CNIs have the highest risk, while mammalian target of rapamycin (mTOR) inhibitors – Rapamycin (Sirolimus) has anti-proliferative effect on in-vitro Post-transplant Lymphoproliferative Disorder (PTLD) derived cell lines) and Epstein-Barr Virus (EBV) status of recipient and donor
Infection remains an important cause in early post-transplant period, especially when patient is discharged from the hospital
Incidence of diarrhea associated with an immunosuppressant is highly variable, and in few trials similar to or slightly more than a placebo.[12,78]
Summary
It is commonly a B-cell type lymphoma associated with Epstein-Barr Virus (EBV) Another form which manifests 3-5 years post LT is usually EBV negative and more aggressive.[70] Risk factors include: age (incidence is more following LT in pediatric population – 10% Vs 1-3% in adults), dose of immunosuppression (risk increases with increase in dose as in acute rejection), type of drugs used (CNIs have the highest risk, while mTOR inhibitors – Rapamycin (Sirolimus) has anti-proliferative effect on in-vitro PTLD derived cell lines) and EBV status of recipient and donor (highest risk in donor positive and recipient negative for EBV).
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call