Diarrhea in liver transplant recipients: etiology and management

Liver Transpl. 2005 Aug;11(8):881-90. doi: 10.1002/lt.20500.

Abstract

Diarrhea is common after liver transplantation (LT). The true incidence of diarrhea in liver transplant recipients is unknown but possibly ranges from 10% to 43% based on a few published studies in other solid organ and bone marrow transplantation. Infectious etiologies, including cytomegalovirus (CMV), Clostridium difficile, and occasional atypical intestinal infections, are the most common causes. Diarrhea is also a frequent side effect of immunosuppressive medications. To variable extents, mycophenolate mofetil (MMF), cyclosporine A (CSA), tacrolimus, and sirolimus are all known to be associated with diarrhea. Rarely, graft-versus-host disease (GVHD), lymphoproliferative disorder, de novo inflammatory bowel disease (IBD), or colon cancer may present as diarrhea. Flare-up of preexisting IBD is also not uncommon after LT. However, the cause of acute diarrhea remains unidentified in 1 of 3 patients. This review summarizes the literature and provides recommendations on the management of acute diarrhea after LT. Although our focus is on LT, the etiology and management recommendations apply to most transplant recipients.

Publication types

  • Review

MeSH terms

  • Colonic Neoplasms / complications
  • Diarrhea / etiology*
  • Diarrhea / microbiology
  • Diarrhea / therapy*
  • Graft vs Host Disease / complications
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Infections / complications
  • Inflammatory Bowel Diseases / complications
  • Liver Transplantation / adverse effects*
  • Lymphoproliferative Disorders / complications

Substances

  • Immunosuppressive Agents