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Causes and management of postrenal transplant diarrhea: an underappreciated cause of transplant-associated morbidity

Shin, Ho Sika,b; Chandraker, Anila

Current Opinion in Nephrology and Hypertension: November 2017 - Volume 26 - Issue 6 - p 484–493
doi: 10.1097/MNH.0000000000000368
DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker

Purpose of review This review highlights the current literature on both infectious and noninfectious diarrhea in renal transplant recipients and provides a diagnostic algorithm for the evaluation of posttransplant diarrhea.

Recent findings Renal transplant recipients share certain predisposing characteristics for the development of posttransplant diarrhea, including a generalized immunosuppressed state and exposure to polypharmacy, most notably broad-spectrum antimicrobial therapy. The main causes of diarrhea after transplantation are infections, immunosuppressive drugs, antibiotics and other drugs. As the cause of posttransplant diarrhea varies greatly depending on several factors, recommending a single optimal diagnostic algorithm is extremely difficult.

Summary Physicians should be familiar with common causes that result in posttransplant diarrhea. A directed approach to diagnosis and treatment will not only help to resolve diarrhea, but also prevent potentially life-threatening consequences, such as loss of the graft. Prospective studies are needed to better assess true prevalence, risk factors and complications of diarrhea by norovirus, rotavirus and adenovirus in kidney transplant patients.

aRenal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

bRenal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea

Correspondence to Anil Chandraker, MD, Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA. Tel: +1 617 732 6383; fax: +1 617 732 5254; e-mail:

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