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.
Curr Opin Nephrol Hypertens. 2017 Nov;26(6):484-493. doi: 10.1097/MNH.0000000000000368.
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.
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.
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.
本文重点介绍了肾移植受者感染性和非感染性腹泻的现有文献，并为移植后腹泻的评估提供了一个诊断算法。
肾移植受者具有某些易患腹泻的特征，包括普遍的免疫抑制状态和暴露于多种药物，尤其是广谱抗菌治疗。移植后腹泻的主要原因是感染、免疫抑制剂、抗生素和其他药物。由于移植后腹泻的原因因多种因素而异，因此很难推荐单一的最佳诊断算法。
医生应熟悉导致移植后腹泻的常见原因。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，如移植物丢失。需要前瞻性研究来更好地评估肾移植患者中诺如病毒、轮状病毒和腺病毒引起的腹泻的真实患病率、风险因素和并发症。
