SAT-350 DIARRHOEA IN RENAL TRANSPLANT RECEPIENTS:- EXPERIENCE FROM A CENTRE IN SOUTH INDIA

Abstract

Diarrhoea is a frequent complication of kidney transplantation with an incidence around 11% to 23%. Causes of diarrhoea can be varied, from infectious to non-infectious etiologies. Since each diarrhoeal episode is an insult to renal allograft, prompt identification of etiology and early initiation of therapy is of paramount importance. This study aimed at assessment of etiologies and risk factors of diarrhoea in renal transplant recipients and the impact of diarrhoea on graft function We did a retrospective analysis of 912 renal allograft recipient records who underwent renal transplantation between January 2006 & June 2019. Patients with severe diarrhoea requiring hospitalization were included in this study. All patients with diarrhoea had undergone investigations like stool microscopy including modified acid fast stain and stool culture. Tests for Cytomegalovirus ( CMV) infection and colonoscopy were performed when indicated Study included 912 renal transplant recepients. There were a total of 618 diarrhoeal episodes in 149 (16.3%) patients. Among 149 patients with post transplant diarrhoea,119 (79%) were males. Fifty eight (39%) patients were deceased donor renal transplant (DDRT)recepients and 91 (61%) were live renal transplant recipients. Significant risk factors were DDRT {58(39%} (p-0.00024), use of induction immunosuppression {44 (29.5%} (p-0.0002) & anti rejection therapy {60(40.3%)}(p-0.0034). Use of Mycophenolate Mofetil({124 (83%} & diabetes mellitus {37 (24.8%)} were not significant risk factors. Diarrhoea within one year of transplantation occurred in 64 (42.9%) patients and 85 (57.1%) had diarrhoea after one year. All patients had received steroid. Eighty three (55.7%) patients were on Tacrolimus-MMF,29 (19.5%) on Cyclosporine (CSA)-MMF, 15 (11%) on CSA-Azathioprine,12 (8%) on MMF alone and 6 (4%) on Azathioprine alone regimen. Infectious cause was identified in 85 (57%) patients, the causes being CMV in 42 (28.2%) patients, protozoal in 36 (24.2%) patients and bacterial in 7 (4.7%) patients. Faecal culture grew E.Coli 3 (2%), Klebsiela 2 (1.3%), Citrobacter 1 (1%) and Shigella 1 (1%). Entamoeba histolytica 16 (10.7%), Giardiasis 8 (5.4%), Strongyloides 5 (3.4%), Cryptosporidium 4 (2.7%), Anchylostoma 2 (1.3%),Microsporidia 1 (0.7%)& Cyclospora 1 (0.7%) were diagnosed by stool microscopy examination. Colonoscopy was done in 19 (12.8%) patients in whom 3 patients had CMV colitis. Hypotension occurred in 46 (31%) patients, leukopenia in 45 (30.2%) and hypokalaemia in 20 (13%) patients. Temporary graft dysfunction during diarrhoeal episode occurred in 67 (45%) patients & 7 (4.7%) required dialysis therapy. After diarrhoeal episode,16 (10.7%) patients developed persistent graft dysfunction & 3 (2%) patients expired. Even after extensive workup, in 64 (42%) patients the cause of diarrhoea could not be identified. 1)Diarrhoea occurred in 16.9% of renal transplant recipients∖t