Introduction:
Diarrhea is a common concern post-transplantation, yet its specific manifestations and underlying causes can vary widely, necessitating a focused study in this geographic region. Understanding these dynamics is crucial for developing tailored management strategies to improve patient care. The study aimed to comprehensively understand the incidence, etiology, outcomes, and severity of diarrhea in renal transplant recipients.
Methods:
An observational cross-sectional study included 157 individuals who underwent renal transplantation within the past two years. The research was conducted at a tertiary care facility for a duration of six months. Patients with a history of acute diarrhea exceeding three months ago were excluded from the analysis. Additionally, individuals admitted with acute abdominal symptoms requiring surgical intervention, such as acute appendicitis or cholecystitis, were excluded. Diarrhea was defined as the passage of more than three loose or liquid stools per day. Acute diarrhea was defined as lasting less than 14 days, while persistent or chronic diarrhea persisted beyond 14 days or one month, respectively. Patients reporting diarrhea were compared with those who did not experience diarrhea post-transplantation. Furthermore, a multivariable logistic regression analysis was conducted, with diarrhea occurrence as the dependent variable and factors including age, sex, drug therapy (immunosuppressant or non-immunosuppressant), and other comorbidities as predictor variables.
Results:
Out of 157 renal transplant recipients, the majority were male (82.8%) with a mean age of 40.32±12.80 years (ranged in age from 13 to 69 years), and had an average BMI of 24.15±4.78 kg/m2. Mean time gap since transplantation was 12.11±7.51 months. Within two years post-transplant, 19.1% experienced diarrhea, with incidences of acute and chronic diarrhea at 10.8% and 8.3%, respectively. Diarrhea disrupted work for 30% and led to hospitalization in 30% of cases, primarily due to dehydration. Graft dysfunction occurred in 36.7% due to diarrhea, with one patient requiring dialysis. The leading aetiology of diarrhea was drug-related (56.6%), followed by cases where the etiology remained unidentified (36.7%), with viral colitis accounting for a smaller percentage (6.7%). Treatment was needed for 93.3%, with alterations in immunosuppressive drugs in 46.7%. All patients recovered without mortality. Significant associations with diarrhea incidence were found for laxative use and history of graft rejection/dysfunction. Multivariate analysis identified recent changes in immunosuppressive medication (OR=3.437; 95% CI=1.343-8.798) and laxative use (OR=0.249; 95% CI=0.067-0.932) as significant predictors of diarrhea incidence, with patients experiencing diarrhea showing higher serum creatinine and urea levels compared to those without diarrhea.
Conclusions:
The study revealed a notable occurrence of diarrhea among renal transplant recipients, with a considerable proportion of cases having an unknown underlying cause. Drug-related aetiology predominantly contributed to identified cases. Importantly, most diarrhea episodes were event-free and did not necessitate hospitalization, and all patients recovered without mortality.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.