Diarrhea is common in transplant recipients. While the majority of cases are mild and transient, some are severe and prolonged, which can threaten graft survival through dehydration. While it is known that some immunosuppressive agents can elicit diarrhea, there does not appear to be any consensus on the role that other nonimmunosuppressive causes can play in transplant patients. The aim of the present open, nonrandomized, multicenter study was to identify nonimmunosuppressive factors involved in severe diarrhea in renal transplant patients. Patients (n = 108) with severe diarrhea (>= 3 stools/day for >= 7 days) were enrolled from 16 Belgian transplant centers. Patients were diagnosed according to an agreed flowchart that consisted of identification of possible infections, followed by changes in empirical and immunosuppressive treatment. Approximately 50% of patients experienced resolution of severe diarrhea following treatment for infections, dietary problems or diarrhea-causing concomitant medications. In conclusion, a large proportion of the severe diarrhea observed in renal transplant recipients is not associated with immunosuppressive therapy and can be treated through anti-infectives, changes to concomitant medication and other empirical treatments. Correct diagnosis of the cause of severe diarrhea in such patients should help to protect graft survival in transplant recipients.
Pescovitz Mark D, Navarro Mercidita T, Immunosuppressive therapy and post-transplantation diarrhea, 10.1111/j.1399-0012.2001.00023.x
Helderman JH, J Am Soc Nephrol, 13, 277 (2002)
Shankar Venugopal K., Zilvetti Miguel, Handa Ashok, Bowler Ian C.J.W., Gray Derek W.R., Chronic Diarrhea and Weight Loss Due to Vibrio parahaemolyticus Infection in a Renal Transplant Recipient : , 10.1097/01.tp.0000128637.16601.48
Maes Bart D., Lemahieu Wim, Kuypers Dirk, Evenepoel Pieter, Coosemansc Willy, Pirenne Jacques, Vanrenterghem Yves F. CH., Differential Effect of Diarrhea on FK506 Versus Cyclosporine A Trough Levels and Resultant Prevention of Allograft Rejection in Renal Transplant Recipients, 10.1034/j.1600-6143.2002.21018.x
Asano T., Nishimoto K., Hayakawa M., Increased tacrolimus trough levels in association with severe diarrhea, a case report, 10.1016/j.transproceed.2004.06.026
Sato Koichiro, Amada Noritoshi, Sato Takaomi, Miura Shunji, Ohashi Yoichi, Sekiguchi Satoshi, Satomi Susumu, Okazaki Hajime, Severe elevations of FK506 blood concentration due to diarrhea in renal transplant recipients, 10.1111/j.1399-0012.2004.00232.x
VALDOVINOS MIGUEL A., CAMILLERI MICHAEL, ZIMMERMAN BRUCE R., Chronic Diarrhea in Diabetes Mellitus: Mechanisms and an Approach to Diagnosis and Treatment, 10.1016/s0025-6196(12)60606-5
Rubin Robert H, Gastrointestinal infectious disease complications following transplantation and their differentiation from immunosuppressant-induced gastrointestinal toxicities, 10.1111/j.1399-0012.2001.00011.x
Pelletier Ronald P, Akin Baris, Henry Mitchell L, Bumgardner Ginny L, Elkhammas Elmahdi A, Rajab Amer, Ferguson Ronald M, The impact of mycophenolate mofetil dosing patterns on clinical outcome after renal transplantation, 10.1034/j.1399-0012.2003.00026.x
Knoll G. A., Mycophenolate Mofetil Dose Reduction and the Risk of Acute Rejection after Renal Transplantation, 10.1097/01.asn.0000079616.71891.f5
Sollinger HW, Transplantation, 60, 225 (1995)
The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group, Transplantation, 61, 1029 (1996)
Pirsch John D., Miller Joshua, Deierhoi Mark H., Vincenti Flavio, Filo Ronald S., A COMPARISON OF TACROLIMUS (FK506) AND CYCLOSPORINE FOR IMMUNOSUPPRESSION AFTER CADAVERIC RENAL TRANSPLANTATION1 : , 10.1097/00007890-199704150-00013
Groth Carl G., Bäckman Lars, Morales José-Maria, Calne Roy, Kreis Henri, Lang Philippe, Touraine Jean-Louis, Claesson Kerstin, Campistol Josep M., Durand Dominique, Wramner Lars, Brattström Christina, Charpentier Bernard, SIROLIMUS (RAPAMYCIN)-BASED THERAPY IN HUMAN RENAL TRANSPLANTATION : Similar Efficacy and Different Toxicity Compared with Cyclosporine1,2, 10.1097/00007890-199904150-00017
Kahan Barry D, Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomised multicentre study, 10.1016/s0140-6736(00)02480-6
, Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroids for prevention of acute rejection, 10.1016/s0140-6736(95)92534-1
Wiesner R, A randomized double-blind comparative study of mycophenolate mofetil and azathioprine in combination with cyclosporine and corticosteroids in primary liver transplant recipients, 10.1053/jlts.2001.23356
Lemahieu Wim, Maes Bart, Verbeke Kristin, Rutgeerts Paul, Geboes Karel, Vanrenterghem Yves, Cytochrome P450 3A4 and P-glycoprotein Activity and Assimilation of Tacrolimus in Transplant Patients with Persistent Diarrhea, 10.1111/j.1600-6143.2005.00844.x
Granger D.K, Enteric-coated mycophenolate sodium: results of two pivotal global multicenter trials, 10.1016/s0041-1345(01)02378-8
Budde Klemens, Curtis John, Knoll Gregory, Chan Lawrence, Neumayer Hans-Hellmut, Seifu Yodit, Hall Michael, , Enteric-Coated Mycophenolate Sodium can be Safely Administered in Maintenance Renal Transplant Patients: Results of a 1-Year Study : EC-MPS in Maintenance Renal Transplant Patients, 10.1046/j.1600-6143.2003.00321.x
Salvadori Maurizio, Holzer Herwig, Mattos Angelo de, Sollinger Hans, Arns Wolfgang, Oppenheimer Federico, Maca Jeff, Hall Michael, , Enteric-Coated Mycophenolate Sodium is Therapeutically Equivalent to Mycophenolate Mofetil inde novoRenal Transplant Patients : EC-MPS inde novoRenal Transplant Patients, 10.1046/j.1600-6143.2003.00337.x
Bibliographic reference
Maes, B. ; Hadaya, K ; De Moor, B ; Cambier, P. ; Peeters, Patrick ; et. al. Severe diarrhea in renal transplant patients: Results of the DIDACT study. In: American Journal of Transplantation, Vol. 6, no. 6, p. 1466-1472 (2006)
