Late, Severe, Noninfectious Diarrhea After Renal Transplantation: High-Risk Factors, Therapy, and Prognosis

Zhao, Yujun; Wen, Jinsheng; Cheng, Ke; Ming, Yingzi; She, Xiaojun; Liu, H.; Liu, L.; Ye, Q.F.; Ding, Banghe

doi:10.1016/j.transproceed.2013.02.131

Cited by 11 publications

(7 citation statements)

References 21 publications

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“…Infectious diarrhea is usually a symptom of gastrointestinal infection caused by a variety of bacteria, viruses, and parasites. Noninfectious diarrhea is caused by many factors, including appendicitis, hypoimmunity, and renal transplantation [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with different pathogens of acute diarrhea in adults in Beijing, China

Jia

Lin

Gao

et al. 2016

J Infect Dev Ctries

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Introduction: Only a small proportion of patients with diarrhea are diagnosed with laboratory tests in China, and most are diagnosed based on clinical symptoms. Therefore, understanding the prevalence of different diarrheal pathogens and their specific symptoms is important. Methodology: Data from a prospective study in Beijing of acute diarrhea and the related pathogens were used to study the association between different pathogen groups and the infected patients' characteristics. A total of 355 patients with acute diarrhea, clinically diagnosed with infectious or noninfectious diarrhea by general practitioners (GPs), were recruited from three districts. Results: Different species of diarrheal pathogens were detected in 133 (37.5%) patients. The most prevalent pathogen was calicivirus (42.9%), followed by rotavirus (30.1%), Vibrio parahaemolyticus (13.5%), and Salmonella spp. (10.5%). The detection rates in patients diagnosed with infectious or noninfectious diarrhea by GPs did not differ significantly ( 2 = 0.026, p = 0.873). Abdominal pain correlated negatively with viral pathogens, whereas nausea, living in the suburbs, and winter infection correlated positively with viral infection. Abdominal pain and leukocytosis were positively associated with bacterial infections, whereas winter infection correlated negatively with them. Conclusion: In this study, we found that the detection rates in patients diagnosed with infectious or noninfectious diarrhea by GPs was the same. We also revealed the improper prescription of antibiotics by GPs based simply on clinical diagnoses. A further analysis of diagnostic accuracy and methods is required to assist GPs in improving their diagnoses when insufficient laboratory tests are available and budgets are limited.

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Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with different pathogens of acute diarrhea in adults in Beijing, China

Jia

Lin

Gao

et al. 2016

J Infect Dev Ctries

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“…Chronic diarrhea is a major problem after transplantation. It substantially reduces quality of life, leads to malabsorption with significant weight loss and oxalate nephropathy , and is associated with reduced graft and patient survival . Although the majority of published studies on post‐transplant diarrhea consider acute and chronic diarrhea in general, in this study we focused on chronic diarrhea, defined as diarrhea lasting for >1 month .…”

Section: Discussionmentioning

confidence: 99%

“…Chronic diarrhea after kidney transplantation is common, yet often neglected despite substantially affecting quality of life and graft and patient survival . The cause of chronic diarrhea in transplant recipients has typically been attributed to drug toxicity , especially related to mycophenolic acid (MPA) .…”

mentioning

confidence: 99%

Intestinal infection at onset of mycophenolic acid‐associated chronic diarrhea in kidney transplant recipients

Moos

Cippà

Wüthrich

et al. 2016

Transplant Infectious Dis

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BACKGROUND: Chronic diarrhea after kidney transplantation is often attributed to mycophenolic acid (MPA) toxicity. We hypothesize that intestinal infections contribute to the pathogenesis of chronic MPA-associated diarrhea. METHODS: In this retrospective study, all patients (n = 726) receiving a kidney transplant between 2000 and 2010 at the University Hospital Zurich were followed until July 2014 for occurrence of chronic diarrhea (4 weeks). Infectious triggers at diarrhea onset were assessed by reviewing medical history, stool microbiology, and histology of colon biopsies. RESULTS: In 46 patients (6.3% of the cohort), a total of 51 episodes of chronic diarrhea during MPA treatment were documented. The diarrhea episodes were often severe, as confirmed by significant weight loss. The cumulative incidence of chronic diarrhea was uniformly distributed throughout the post-transplant period, with 2.0%, 5.1%, and 9.6% at 1, 5, and 10 years, respectively. Evidence was found for intestinal infection at diarrhea onset in 38 episodes (74.5%). Occurrence of diarrhea onset showed a seasonal distribution with peaks in April and October/November. Specific antimicrobial treatment alone was associated with a 19% resolution rate only, whereas combination with dose reduction of MPA or switch from mycophenolate mofetil to enteric-coated mycophenolate sodium resulted in a 22.7% and 76.5% resolution rate, respectively. Change to an MPA-free regimen was associated with a 100% resolution rate. CONCLUSION: These results provide first evidence for a contribution of intestinal infections in chronic post-transplant diarrhea associated with MPA treatment.

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“…Rate of diarrhea was 7.3% in the postconversion of cyclosporine > tacrolimus group and 7.4% in the tacrolimus group. 28 It has been recently shown that the cause of posttransplant diarrhea is frequently related to infections caused by enteric pathogens. Chronic norovirus-related diarrhea remains a major concern, often leading to MMF discontinuation and thereby to increased rejection.…”

Section: Abbreviation: Gsrs Gastrointestinal Symptoms Rating Scalementioning

confidence: 99%

Untitled

Królikowski

Pawłowicz²,

Budzisz³

et al. 2016

Exp Clin Transplant

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Objectives: Although immunosuppressive drugs have been recognized as leading causes of gastrointestinal symptoms after kidney transplant, other widely used medications such as proton-pump inhibitors recently have been implicated. Our aim was to study the effects of chronic proton-pump inhibitor therapy on gastrointestinal symptoms in clinically stable patients late after kidney transplant. Materials and Methods:The study comprised 100 kidney transplant recipients (66 men and 34 women, mean age of 49 ± 12 y, mean time after transplant of 56 ± 46 mo). All patients completed the Gastrointestinal Symptoms Rating Scale and the Quality of Life Questionnaire SF-8 surveys. Results:The most commonly reported symptoms included borborygmus (27%), flatulence (23%), abdominal distension (18%), urgent need of defecation (17%), and heartburn, acid reflux, and eructation (13%). Proton-pump inhibitors were chronically used by 50% of patients and sporadically by 33%. Gastrointestinal Symptoms Rating Scale scores were higher in patients who used proton-pump inhibitors (mean score of 7.8 ± 5.5 vs 4.6 ± 3.0; P = .013). Total score of items representing diarrhea in the Gastrointestinal Symptoms Rating Scale (increased passage of stools, loose stools, urgent need of defecation, incomplete evacuation) was higher in patients treated with proton-pump inhibitors than in those not treated (2.3 ± 2.2 vs 1.3 ± 1.9; P = .04). Conclusions: Chronic use of proton-pump inhibitors may increase the prevalence of gastrointestinal symptoms, particularly diarrhea, in patients late after kidney transplant.

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Late, Severe, Noninfectious Diarrhea After Renal Transplantation: High-Risk Factors, Therapy, and Prognosis

Cited by 11 publications

References 21 publications

Prevalence and factors associated with different pathogens of acute diarrhea in adults in Beijing, China

Prevalence and factors associated with different pathogens of acute diarrhea in adults in Beijing, China

Intestinal infection at onset of mycophenolic acid‐associated chronic diarrhea in kidney transplant recipients

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