Early ileocolonoscopy with biopsy for the evaluation of persistent post-transplantation diarrhea.
OBJECTIVE
To investigate the significance of ileocolonoscopy with histology in the evaluation of post-transplantation persistent diarrhea (PD).


METHODS
We retrospectively reviewed all records of renal transplant patients with PD, over a 3-year period. All patients were referred for ileocolonoscopy with biopsy, following a negative initial diagnostic work up. Clinical and epidemiological data were compared between cases with infectious or drug-induced diarrhea.


RESULTS
We identified 30 episodes of PD in 23 renal transplant patients (1-3 cases per patient). There were 16 male patients and the mean age at the time of PD was 51.4 years. The average time from transplantation to a PD episode was 62.3 +/- 53.2 mo (range 1-199 mo). Ileocolonoscopy detected mucosal abnormalities in 19 cases, whereas the intestinal mucosa appeared normal in 11 cases. Histological examination achieved a specific diagnosis in 19/30 cases (63.3%). In nine out of 11 cases (82%) with normal endoscopic appearance of the mucosa, histological examination of blinded biopsies provided a specific diagnosis. The etiology of PD was infectious in 11 cases (36.6%), drug-related in 10 (33.3%), of other causes in three (10%), and of unknown origin in six cases (20%). Infectious diarrhea occurred in significantly longer intervals from transplantation compared to drug-related PD (85.5 +/- 47.6 mo vs 40.5 +/- 44.8 mo, P < 0.05). Accordingly, PD due to drug-toxicity was rarely seen after the first year post-transplantation. Clinical improvement followed therapeutic intervention in 90% of cases. Modification of immunosuppressive regimen was avoided in 57% of patients.


CONCLUSIONS
Early ileocolonoscopy with biopsies from both affected and normal mucosa is an important adjunctive tool for the etiological diagnosis of PD in renal transplant patients.
Bamias
Giorgos
G
Gastroenterology Division, 1st Department of Internal Medicine, Propaedeutic, Medical School, University of Athens, Laikon Hospital, 11527, Athens, Greece. gbamias@gmail.com
Boletis
John
J
Argyropoulos
Theodoros
T
Skalioti
Chrysanthi
C
Siakavellas
Spyros I
SI
Delladetsima
Ioanna
I
Zouboulis-Vafiadis
Irene
I
Daikos
George L
GL
Ladas
Spiros D
SD
D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D003967:Diarrhea / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D042241:Early Diagnosis; D005260:Female; D006115:Greece; D006801:Humans; D007082:Ileum / Q000473:pathology*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007413:Intestinal Mucosa / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
D007166:Immunosuppressive Agents