University of Oklahoma Health Sciences Center , Oklahoma City, OK , USA.
Curr Med Res Opin. 2013 Oct;29(10):1315-28. doi: 10.1185/03007995.2013.816278. Epub 2013 Aug 1.
To provide a comprehensive review of the literature as it relates to diarrhea in solid organ transplant (SOT) recipients. In this article, we review the epidemiology, pathogenesis, clinical manifestations, diagnosis and management of diarrhea in SOT recipients and discuss recent advances and challenges.
Two investigators conducted independent literature searches using PubMed, Web of Science, and Scopus until January 1st, 2013. All databases were searched using a combination of the terms diarrhea, solid organ transplant, SOT, transplant associated diarrhea, and transplant recipients. Articles that discussed diarrhea in SOT recipients were reviewed and relevant cross-references also read and evaluated for inclusion. Selection bias could be a possible limitation of the approach used in selecting or finding articles for this article.
Post-transplant diarrhea is a common and distressing occurrence in patients, which can have significant deleterious effects on the clinical course and well-being of the organ recipient. A majority of cases are due to infectious and drug-related etiologies. However, various other etiologies including inflammatory bowel disease must be considered in the differential diagnosis. A step-wise, informed approach to post-transplant diarrhea will help the clinician achieve the best diagnostic yield. The use of diagnostic endoscopy should be preceded by exclusion of an infectious or drug-related cause of diarrhea. Empiric management with antidiarrheal agents, probiotics, and lactose-free diets may have a role in managing patients for whom no cause can be determined even after an extensive investigation.
Physicians should be familiar with the common etiologies that result in post-transplant diarrhea. A directed approach to diagnosis and treatment will not only help to resolve the diarrhea but also prevent potentially life-threatening consequences including loss of the graft as well. Prospective studies are required to determine the etiology of post-transplant diarrhea in different clinical and geographic settings.
对与实体器官移植（SOT）受者腹泻相关的文献进行全面综述。在本文中，我们综述了 SOT 受者腹泻的流行病学、发病机制、临床表现、诊断和治疗，并讨论了最新进展和挑战。
两名研究人员使用 PubMed、Web of Science 和 Scopus 进行了独立的文献检索，检索时间截至 2013 年 1 月 1 日。所有数据库均使用腹泻、实体器官移植、SOT、移植相关腹泻和移植受者等术语的组合进行搜索。综述了讨论 SOT 受者腹泻的文章，并阅读了相关的交叉引用文章以评估是否纳入。在选择或查找本文文章时，选择偏倚可能是一种可能的方法局限性。
移植后腹泻是患者常见且令人痛苦的疾病，会对器官受者的临床过程和健康产生重大不利影响。大多数病例是由感染和药物相关病因引起的。然而，在鉴别诊断中必须考虑各种其他病因，包括炎症性肠病。对移植后腹泻进行逐步、知情的处理有助于临床医生获得最佳的诊断效果。在进行诊断性内镜检查之前，应排除腹泻的感染或药物相关原因。即使在广泛调查后仍无法确定病因，也可以使用止泻药、益生菌和无乳糖饮食等经验性治疗方法来治疗患者。
医生应熟悉导致移植后腹泻的常见病因。有针对性的诊断和治疗方法不仅有助于解决腹泻问题，还可以预防潜在的危及生命的后果，包括移植物丢失。需要前瞻性研究来确定不同临床和地理环境中移植后腹泻的病因。
