Diarrhea in solid organ transplant recipients

Angarone, Michael; Ison, Michael G.

doi:10.1097/qco.0000000000000172

Cited by 45 publications

(36 citation statements)

References 78 publications

(101 reference statements)

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“…The most common infectious causes of diarrhea following transplant include Norovirus, Clostridioides difficile, and Cytomegalovirus . Norovirus is a common cause of acute gastroenteritis in adults and is self‐limiting in immunocompetent hosts .…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Norovirus diarrheal infections and Clostridioides difficile infections in kidney transplant recipients: A single‐center retrospective study

Rolak¹,

Bartolomeo²,

Jorgenson

et al. 2019

Transplant Infectious Dis

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Recently, Norovirus has been recognized as an important cause of diarrheal infection in kidney transplant recipients (KTRs). We assessed the risk factors and outcomes of Norovirus diarrheal infections (NVDI) and Clostridioides difficile infection (CDI) on graft and patient survival following kidney transplant (KT). We examined KTRs transplanted at our center between 1994 and 2014, and compared those who suffered from NVDI and CDI with patients who did not develop either infection. Each patient with NVDI or CDI was matched with five controls based on time from transplant. Of the 4941 KTs performed during the study period, there were 2112 evaluable cases: 66 NVDI cases, 286 CDI cases, and 1760 controls. Median uncensored graft survival following infection was 497.5 days for the NVDI group, 440 days for the CDI group, and 1271 days for controls. Those with CDI had significantly inferior graft survival than controls (HR 2.41; CI 2.01, 2.90; P < 0.001), and those with NVDI had a 23% lower risk of graft survival than controls (HR 1.23; CI 1.0, 1.52; P = 0.054). Diarrheal infection after KT is associated with reduced long‐term graft survival.

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Section: Discussionmentioning

confidence: 99%

“…Several studies have identified Norovirus and Clostridioides difficile infections (CDI) as important causes of post‐transplant infection that may have adverse effects on KTR graft function and mortality . However, there is limited information on the causative factors and complications of diarrheal infections in KTRs .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Norovirus diarrheal infections and Clostridioides difficile infections in kidney transplant recipients: A single‐center retrospective study

Rolak¹,

Bartolomeo²,

Jorgenson

et al. 2019

Transplant Infectious Dis

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“…In the present study, the prevalence of severe diarrhoea requiring hospitalization was 4.9% in total kidney transplant recipients. Previous studies have shown that diarrhoea in kidney transplant recipients is associated with a higher risk of graft dysfunction and all‐cause mortality . The present study supported those results, and additionally conducted stratified analyses by aetiology and immunosuppressant regimen.…”

Section: Discussionmentioning

confidence: 99%

Effect of severe diarrhoea on kidney transplant outcomes

Kim

et al. 2019

Nephrology

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Aim In addition to immunological complications, non‐immunological events should be considered following kidney transplantation. Among them, diarrhoea is the most common gastrointestinal complication, but its effect on transplant outcomes remains unclear. Methods This retrospective study enrolled patients who underwent kidney transplantation between May 1993 and December 2017. Patients with diarrhoea as the chief complaint at admission were defined as the diarrhoea group. Transplant outcomes were compared between the diarrhoea and non‐diarrhoea groups. Results Among a total of 1704 kidney recipients, severe diarrhoea that required hospitalization was identified in 84 (4.9%) patients. Patients with diarrhoea showed higher risks of graft failure (adjusted hazard ratio, 4.77 (2.98–7.64)) and all‐cause mortality (adjusted hazard ratio, 7.17 (4.09–12.58)) than did patients without diarrhoea. The risk of de novo donor‐specific antibody was also elevated in the diarrhoea group, although there was no change in the risk of biopsy‐proven rejection. In subgroup analysis, the aetiology of diarrhoea, as well as a change in immunosuppressant following diarrhoea, showed no significant differences in graft survival. However, incomplete recovery from concurrent acute kidney injury was significantly associated with graft loss. Conclusion Diarrhoea is related to poor graft and patients’ outcomes in kidney recipients. An effort to recover from concurrent acute kidney injury is important for improved graft survival.

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“…Diarrhea is a common complication in solid organ transplant recipients with an estimated prevalence of 20–50% . It can become a chronic and debilitating problem in transplant recipients due to their impaired ability to combat infections .…”

Section: Introductionmentioning

confidence: 99%

Use of oral immunoglobulins to treat diarrhea in pediatric kidney transplant recipients—Single‐center experience and review of the literature

Kizilbash

Sudel

Anderson

et al. 2019

Pediatric Transplantation

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Effective treatment modalities for diarrhea in solid organ transplant recipients are lacking. We evaluated the effect of oral IgG on clinical course of diarrhea in pediatric kidney transplant recipients. We retrospectively studied all pediatric kidney transplant recipients who required hospitalization for diarrhea between January 1, 2015, and December 31, 2017. We divided the recipients into two groups based on whether they had received oral IgG to treat diarrhea. Sixteen pediatric kidney transplant recipients required hospitalization for diarrhea over 3 years. Median age at admission was 9.25 years (IQR:12.54). Fifty‐six percent of recipients were male, and 81% were white. Four patients received oral IgG for prolonged diarrhea. Oral IgG recipients had longer diarrheal duration before admission (median (days) 14.5 vs1; P .02), a trend for greater weight loss at admission (median (kilogram) 1.4 vs 0.2; P .3), and a trend for higher acute kidney injury (>75% reduction in glomerular filtration rate: 100% vs 42%; P .36). Diarrhea resolved completely in 3 (75%) oral IgG recipients and 7 (58%) non‐oral IgG patients by discharge (P .99). One oral IgG recipient showed partial improvement but also had biopsy evidence of mycophenolate‐induced colitis. All patients tolerated oral IgG well. No patients required re‐hospitalization within 30 days of discharge. Oral IgG may be used safely and effectively to treat prolonged diarrhea in pediatric kidney transplant recipients. A larger, randomized, prospective study is needed to further assess the efficacy of oral IgG in the treatment of diarrhea.

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Diarrhea in solid organ transplant recipients

Abstract: New epidemiologic data and new testing techniques offer an opportunity for research into better testing strategies for transplant patients with diarrhea. These newer testing strategies may offer better insight into the cause of diarrhea and more appropriate treatment for this illness.

Cited by 45 publications

References 78 publications

Outcomes of Norovirus diarrheal infections and Clostridioides difficile infections in kidney transplant recipients: A single‐center retrospective study

Outcomes of Norovirus diarrheal infections and Clostridioides difficile infections in kidney transplant recipients: A single‐center retrospective study

Effect of severe diarrhoea on kidney transplant outcomes

Use of oral immunoglobulins to treat diarrhea in pediatric kidney transplant recipients—Single‐center experience and review of the literature

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