• G. Gowthaman Senior Resident, Department of Nephrology, Tamilnadu Dr. M. G. R. Medical University, Chennai, Tamilnadu, India
  • N. D. Srinivasaprasad Assistant Professor, Department of Nephrology, Tamilnadu Dr. M. G. R. Medical University, Chennai, Tamilnadu, India
  • K. Thirumalvalavan Assistant Professor, Department of Nephrology, Tamilnadu Dr. M. G. R. Medical University, Chennai, Tamilnadu, India
  • S. Sujith Assistant Professor, Department of Nephrology, Tamilnadu Dr. M. G. R. Medical University, Chennai, Tamilnadu, India
  • M. Edwin Fernando Prof & Head, Department of Nephrology, Gout. Stanley Hospital, Chennai
  • R. Selvi Prof & Head, Department of Microbiology, Gout. Stanley Hospital, Chennai
Keywords: Post-transplant diarrhea, immunesuppression, infection


Background and Objectives: Post-transplant diarrhea is a frequent complication of renal transplantation. Post-transplant diarrhea is associated with reduced quality of life1, hastened decline of graft function and higher mortality2. Diarrhea is often neglected by patients and clinicians and considered as a side effect of immunosuppressive regimens. The aim of this study is to identify the etiology, clinical profile, and outcome of diarrhea in renal transplant recipients.

Patients and Methods: Over 1-year period renal transplant recipients with diarrhea were analyzed. Diarrhea was defined as three or more semisolid or liquid stools per day for minimum of 3 days duration. After obtaining detailed history, patients were subjected to clinical examination. Blood samples were collected for biochemical investigations and stool samples for microbiological examination. We adopted DIDACT protocol for investigating the diarrheal episode in recipients3.

Results: A total of 46 patients were enrolled in this study. Males were predominant in number 36 (78.2%). This included 33 live related renal transplant recipients (LRRTR) and 13 deceased donor renal transplant recipients (DDRTR). The mean age of the patients was 33.2±9.12 years. A majority of them had diarrhea after 1 year of transplantation (n= 29, 63.1%). Infective causes were identified in 6 patients and optimization of immunosuppression’s was done in 11 patients.

Conclusion: In our study, most of the recipients (63.1%) had diarrhea after one year of renal transplantation. The cause of Diarrhea was unclear in a significant number (n=22) of the study population.


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1. Ekberg H, Kyllonen L, Madsen S, et al. Clinicians underestimate gastrointestinal symptoms and overestimate quality of life in renal transplant recipients: aGowthaman G. et al., Med. Res. Chronicles., 6(1), 34-39 2019 multinational survey of nephrologists. Transplantation 2007;84:1052.
2. Bunnapradist S, Neri L, Wong W, et al. Incidence and risk factors for diarrhea following kidney transplantation and association with graft loss and mortality.
Am J Kidney Dis. 2008;51:478.
3. Severe Diarrhea in Renal Transplant Patients: Results of DIDACT Study, Amer. Journal of Transplantation 2006;6: 1466- 1472
4. Pescovitz MD, Navarro MT. Immunosupressive therapy and posttransplantation diarrhea. Clin transplant 2001;15(Suppl 4): 23-28.
5. Helderman JH, Goral S. Gastrointestinal complications of transplant immunosuppression. J AM Soc Nephrol 2002; 13:277-287
6. Lemahieu W,Maes B, Verbeke K, et al.Cytochrome P450 3A4 and P glycoprotein activity and assimilation of tacrolimus in transplant patients with persistent diarrhea. Am J Transplant 2005;5: 1383
7. Bunnapradist S, Lentine KL, Burroughs TE, et al. Mycophenolate mofetil dose reductions and discontinuations after gastrointestinal complications are associated with renal transplant graft failure. Transplantation 2006; 82:102
8. Takemoto SK, Pinsky BW, Schnitzler MA et al. A retrospective analysis of immunosupperssion compliance, dose reduction and discontinuation in kidney ransplant recipients. Am J Transplant 2007;7:2704
9. Knoll GA, Mac Donald I, Khan A, et al. Mycophenolate mofetil dose reduction and the risk of acute rejection after renal transplantation. J Am Soc Nephrol
10. Altiparmak MR, Trablus S, Pamuk ON et al. Diarrhoea following renal transplantation. Clin Transplant 2002; 16: 212-216.
11. Fishman JA, Rubin RH. Infection in organ-transplant recipients, N Engl J Med 1998;338:1741-1751
12. Rubin RH. Gastrointestinal infections disease complications following transplantation and their differentiation from immunosuppressant- induced gastrointestinal toxicities. Clin Transplant 2001;15(Suppl 4):11-22
13. Durand CM,Marr KA,Arnold CA,et al.Detection of cytomegalovirus DNA in plasma as an adjunct diagnostic for gastrointestinal tract disease in kidney and liver transplant recipients.Clin Infect Dis 2013;57:1550.
14. Diarrhea After Kidney Transplantation: A New look at a Frequent symptom, Transplantation, volume 98,Number8
15. Minz M,Udgiri NK,Heer MK,et al.Cryptosporidiasis in live related renal tranaplant recipients:a single center experience. Transplantation 2004;77:1916.
16. Luan FL, Chopra P, Park J, Norman S, Cibrik D, Ojo A, Efficacy of valganciclovir in the treatment of cytomegalovirus disease in kidney and pancreas transplant recipients. Transplant Proc 2006;38:3673-5.
17. Humar A, Siegal D, Moussa G, Kumar D,A prospective assessment of valganciclovir for the treatment of cytomegalovirus infection and disease in transplant recipients. J Infect Dis 2005;192:1154-7.
How to Cite
G. Gowthaman, N. D. Srinivasaprasad, K. Thirumalvalavan, S. Sujith, M. Edwin Fernando, R. Selvi. DIARRHEA IN RENAL TRANSPLANT RECIPIENTS – A CROSS SECTIONAL STUDY. Med. res. chronicles [Internet]. 2019Feb.28 [cited 2023Dec.4];6(1):34-9. Available from: https://medrech.com/index.php/medrech/article/view/364
Original Research Article