Causes and Long-Term Consequences of Diarrhea After Kidney Transplantation.

A. Devresse,¹ F. Aulagnon,² A. Scemla,² L. Morin,² F. Lanternier,³ D. Anglicheau,² O. Lortholary,³ C. Legendre,² V. Avettand-Fenoel,⁴ J. Zuber.²

¹Nephrology Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
²Kidney Transplant and Intensive Care Unit, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
³Infectious and Tropical Diseases Unit, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
⁴Virology Unit, Hôpital Necker-Enfants Malades, AP-HP, Paris, France

Meeting: 2017 American Transplant Congress

Abstract number: 126

Keywords: Graft survival, Infection

Session Information

Session Name: Concurrent Session: Kidney Clinical Complications 1

Session Type: Concurrent Session

Date: Sunday, April 30, 2017

Session Time: 4:30pm-6:00pm

Presentation Time: 4:54pm-5:06pm

Location: E354a

Background

The causes and effects of diarrhea on graft outcomes have been poorly investigated in a large cohort of well-phenotyped kidney transplant recipients (KT). The epidemiological burden and presentation of Norovirus (Nov) infection in unselected KT also remained to be clarified.

Methodology

Between 2010 and 2011, 195 KT who underwent extensive infection workup for post-transplant diarrhea, were enrolled in the study. Patients with NoV infection ([laquo] NoV group [raquo],n=59) were compared to patients with other causes ([laquo] non-NoV group [raquo],n=136). A diarrhea-free KT control group was selected from our database (2004-2016) ([laquo] control group [raquo],n= 151), matched by transplant date, and compared to the cases ([laquo] diarrhea group [raquo],n=151).

Results

NoV was the leading cause (30%). NoV-associated diarrhea (n=59) was associated with longer duration of symptoms (226±352 vs 128±226 days, P= 0.003), higher rates of chronic diarrhea (76% vs 52%, p= 0.002), acute kidney graft failure (59% vs 38%, p= 0.006), hospitalization (61% vs 36%, p= 0.002) and greater weight loss (7%±5% vs 3%±4%, p= 0.001) than non-NoV-related diarrhea. Mycophenolate reduction was more frequent (81% vs 50%,P= 0.0001) and more pronounced (-78%±26% vs -66%±31%,P=0.02) in the Nov group.

When comparing cases with controls, 5 years death-censored graft survival was lower in the cases (91% vs 98%, P= 0.01). The poor functional outcome associated with diarrhea was particularly striking in recipients of grafts from expanded criteria donor (ECD). Multivariate analysis retained diarrhea as an independent factor associated with 5 years-graft loss risk in ECD (p=0.042).

Conclusion

NoV is the leading cause of diarrhea after KT and is associated with a more severe presentation. Diarrhea decreases graft survival especially in recipients of ECD allografts.

CITATION INFORMATION: Devresse A, Aulagnon F, Scemla A, Morin L, Lanternier F, Anglicheau D, Lortholary O, Legendre C, Avettand-Fenoel V, Zuber J. Causes and Long-Term Consequences of Diarrhea After Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Devresse A, Aulagnon F, Scemla A, Morin L, Lanternier F, Anglicheau D, Lortholary O, Legendre C, Avettand-Fenoel V, Zuber J. Causes and Long-Term Consequences of Diarrhea After Kidney Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/causes-and-long-term-consequences-of-diarrhea-after-kidney-transplantation/. Accessed November 22, 2024.

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