Diarrhea in kidney transplant recipients: Etiology and outcome

Sonambekar, Ajinkya; Mehta, Vatsal; Desai, Devendra; Abraham, Philip; Joshi, Anand; Gupta, Tarun; Sirsat, Rasika; Kothari, Jatin

doi:10.1007/s12664-020-01022-1

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…In study of etiological agent of diarrhea in transplant recipients from Northern India and Western India, diarrhea was caused by infectious agents in 65% and 51% respectively. 10,11 Similar to the present study, studies from Turkey and Belgium had reported infectious agents were the etiology in 30-40%. 7,9,12 However, in a single-centre study from USA, no specific etiology was identified in majority (70%) of the episodes.…”

Section: Discussionsupporting

confidence: 89%

“…Similarly, C difficile was the commonest bacterial pathogen identified in the single-centre study from USA 8 In this study, 30% diarrheal episodes were related to immunosuppression drugs. In other studies from India, immunosuppression drugs was the etiology in 17-38% 10,11,13 Based on cost analysis of diagnostic tests done for evaluating diarrhea in solid organ transplant recipients, it has been recommended to do step-wise testing strategy for community-onset diarrhea. In first step, testing for C difficile, CMV, and food-borne bacterial enteropathogens was recommended.…”

Section: Ta B L E 3 Diagnostic Yield Of Investigationsmentioning

confidence: 99%

“…There are limited data regarding the etiology of diarrhea in solid organ transplant recipients from India. 10,11 The aim of this study was to 1) study the etiological profile of diarrhea in solid organ transplant recipients in India and 2) evaluate the diagnostic yield of standard diagnostic modalities used for evaluation of post-transplant diarrhea.…”

Section: Introductionmentioning

confidence: 99%

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Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India

Vyas

Parameswaran

Paramasivan

et al. 2021

Transplant Infectious Dis

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Background: Diarrhea is one of the common gastrointestinal (GI) adverse events after solid organ transplantation. Diarrhea may be caused by infectious or non-infectious etiology. The infectious etiology of diarrhea varies according to the location and duration of diarrhea. Non-infectious etiologies include drugs, inflammatory bowel disease, neoplasia. The objective of this study was to evaluate the etiological profile of diarrhea in solid organ transplant recipients presenting to a tertiary care center in Southern India.Methods: This was a retrospective analysis of prospectively collected data of all solid organ transplantation recipients referred to the Department of Medical Gastroenterology for evaluation of diarrhea from April 2012 till May 2014. All patients had stool evaluated by wet mount examination, modified acid fast (AFB) stain, trichrome stain, culture, and Clostridium difficile toxin assay. EDTA plasma was collected for quantitative Cytomegalovirus (CMV) detection by real-time PCR. If the diarrhea was acute (<2 wk), and no etiological agent was identified, empirical antibiotic therapy was instituted and followed up. If persistent or chronic diarrhea (>2-4 wk), endoscopic evaluation (upper GI endoscopy and/or colonoscopy with biopsies), depending on the clinical type of diarrhea was done. If no specific etiological diagnosis was established after endoscopic evaluation, breath test for SIBO and celiac serology were done. If no specific etiology was identified after the above investigations, dose of immunosuppressive drugs was reduced. If diarrhea responded to dose reduction, it was considered to be drug related.Results: Fifty-eight episodes of diarrhea occurred in 55 solid organ transplant recipients during the study period. Renal transplant recipients constituted the majority (70%). Most (79%) of patients included in the study had their transplant > 6 mo ago.Infective diarrhea was the etiology in 46%, drug-related diarrhea in 29.3%. No specific etiology was identified in 22.4% of patients. Parasites accounted for 69% of all

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Section: Discussionsupporting

confidence: 89%

Section: Ta B L E 3 Diagnostic Yield Of Investigationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India

Vyas

Parameswaran

Paramasivan

et al. 2021

Transplant Infectious Dis

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“…[ 12 ] The former may also explain the higher number of episodes being due to an infectious etiology in our study (64.3%) in comparison to that reported from the USRDS data (16.7%). [ 3 ] The higher prevalence of infections cause (compared to the reported Indian studies) may have to do with the detailed protocol-based evaluation of each episode and the number of infectious episodes was similar to another Indian study[ 13 ] which reported more than half of episodes being due to infectious causes.…”

Section: Discussionsupporting

confidence: 54%

Diarrhea after kidney transplantation

Patil,

Saxena,

Thakare

et al. 2023

Journal of Postgraduate Medicine

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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.

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“…However, the role of gut microbiota, being called “the second genome,” in the pharmacokinetics of CSA might be neglected. Studies mentioned that there could be higher risks of graft failure and all-cause mortality in transplant patients with diarrhoea than patients without diarrhoea, but adjusting the dose of immunological agents could improve about 20% of these patients’ graft survival ( Kim et al, 2020 ; Sonambekar et al, 2020 ). This suggests that microbiota disturbance is a potential factor affecting the pharmacokinetics of cyclosporine A.…”

Section: Introductionmentioning

confidence: 99%

Effects of intestinal microbiota on pharmacokinetics of cyclosporine a in rats

et al. 2022

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BackgroundIntestinal microbiota has been confirmed to influencing the pharmacokinetic processes of a variety of oral drugs. However, the pharmacokinetic effects of the gut microbiota on cyclosporine A, a drug with a narrow therapeutic window, remain to be studied.MethodTwenty-one rats were randomly divided into three groups: (a) control group (CON), (b) antibiotic treatment group (ABT) and (c) fecal microbe transplantation group (FMT). The ABT group was administrated with water containing multiple antibiotics to deplete microorganisms. FMT was with the same treatment, followed by oral administration of conventional rat fecal microorganisms for normalization.ResultThe bioavailability of CSA increased by 155.6% after intestinal microbes were consumed by antibiotics. After intestinal microbiota reconstruction by fecal transplantation, the increased bioavailability was significantly reduced and basically returned to the control group level. Changes in gut microbiota alter the protein expression of CYP3A1, UGT1A1 and P-gp in liver. The expressions of these three proteins in ABT group were significantly lower than those in CON and FMT groups. The relative abundance of Alloprevolleta and Oscillospiraceae UCG 005 was negatively correlated with CSA bioavailability while the relative abundance of Parasutterella and Eubacterium xylanophilum group was negatively correlated with CSA bioavailability.ConclusionIntestinal microbiota affects the pharmacokinetics of CSA by regulating the expression of CYP3A1, UGT1A1 and P-GP.

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Diarrhea in kidney transplant recipients: Etiology and outcome

Cited by 10 publications

References 15 publications

Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India

Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India

Diarrhea after kidney transplantation

Effects of intestinal microbiota on pharmacokinetics of cyclosporine a in rats

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