title: Effect of Prolonged Diarrhea in Renal Transplant Recipients at a Single Center in Taiwan.
abstract: OBJECTIVE
  Post-renal transplantation diarrhea is a common complication; however, it is easily ignored. This study aimed to determine the factors influencing graft function for renal transplant recipients with diarrhea.
  
  
  METHODS
  A single-center retrospective study with the use of the Hyperion data warehouse was conducted to search and evaluate for renal transplant recipients who came for medical care for diarrhea at our transplant center from January 2009 to August 2015. The clinical features of patients with diarrhea were compared with the features of recipients without diarrhea. The causes and risk factors of post-transplantation diarrhea were also evaluated.
  
  
  RESULTS
  For the 67 patients collected for the study, infectious diarrhea (ID) was confirmed in 27 patients (40.3%), and the most common causes were cytomegalovirus and Clostridium difficile infection. A significant difference was found between ID and noninfectious (NID) groups for serum creatinine change (0.31 ± 0.51 vs 0.1 ± 0.27 mg/dL; P = .0319), revealing that the impact of diarrhea on renal function was greater for ID patients. When diarrhea of ≥10 days was used as a cutoff for serum creatinine change, the change of serum creatinine became greater when the diarrhea period was longer (<7 d vs >14 d: 0.07 ± 0.22 vs 0.55 ± 0.6 mg/mL; P = .0001).
  
  
  CONCLUSIONS
  Infectious diarrhea does more damage to the kidney graft than NID in transplant recipients. If the period of diarrhea is lengthened to >10 days, the renal function of the graft would be impaired and irreversible graft loss would be expected.
authors.affiliation: Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan; College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Wang
authors.affiliation: School of Pharmacy, and Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan; Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: M-K
authors.initials: MK
authors.lastname: Yeh
authors.affiliation: Department of General Surgery, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Y-F
authors.initials: YF
authors.lastname: Tian
authors.affiliation: College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: yabihu@kmu.edu.tw.
authors.forename: Y-B
authors.initials: YB
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D066027:Transplant Recipients