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Acute diarrhea is common in developing country; it is not infrequent problem in renal transplant recipient in early post-operative period. Patients do not think diarrhea as an important problem as they are used to acute diarrhea in their life. On the other hand, clinicians consider acute diarrhea in early post-operative period as a side effect of immunosuppressive regimens. This study aimed to identify the prevalence of diarrhea in early post-operative period (3 weeks after transplant) and its relation to blood tacrolimus trough level in living donor kidney transplant (LDKT) recipients.
LDKT recipients having acute diarrhea in early post-transplant period were analyzed from 2014 to 2023 September. After obtaining diet history and physical examination, laboratory tests were done; their response to management was recorded.
A total of 230 recipients were included. The age ranged from 14 to 73 years. Thirteen percent of recipients had acute diarrhea. A majority of them had mild form; mild dehydration. The peak onset was 4 to 5 days after transplant. They did not have oral candidiasis. Total WBC count was normal except in two cases. Dietary modification, and oral replacement therapy with oral rehydration solution were done to all recipients; motion was back to normal in sixteen percent (5/30). Probiotics/folic acid therapy made resolution of diarrhea in 30% (9/30).
Stool examination did not show trophozoite or cyst. Stool for Clostridium difficile toxin was not identified. Anti-infective therapy was given in 3 cases; norfloxacin to 2 cases. Intravenous colistin to one case as stool culture showed Carbepenem resistant Klebsiella pneumonia.
Blood level of mycophenolate mofetil was normal; it was kept in the same dose if there was no leucopenia or thrombocytopenia. One third of the recipients having diarrhea (10/30) had raised blood tacrolimus trough level. Twenty-four to forty-eight hours after dose reduction of tacrolimus, they passed formed stool; and their serum creatinine level decreased.
In this study, 13% of the LDKT recipients had acute diarrhea in early post-operative period. Majority of them are mild form. Half of them recovered with oral rehydration solution, diet modification, probiotics and folic acid. Raised blood tacrolimus trough level was found in 33% of them; diarrhea improved dramatically after reduction of tacrolimus dose. Acute diarrhea may be one manifestation of tacrolimus toxicity in early post-operative period.