Diarrhea in a renal transplant patient

Investigations

• Stool culture, ova and parasites, and viral PCR
• Serum CMV viral load
• Consider ¹⁴C-glycocholic acid or D-xylose breath tests, if available, for small bowel overgrowth
• Consider colonoscopy

Management

• Assess medications and stop any that may be contributing to diarrhea
• Assess for infectious causes with stool culture, O&P, and viral PCR
• Adjust immunosuppression, if able
• Colonoscopy with biopsies
• Supportive treatment with antidiarrheal medications, probiotics, and dietary modification (including lactose-free)

Further Reading

• Severe Diarrhea in Renal Transplant Patients: Results of the DIDACT Study. Am J Transplantation. 2006;6(6):1446-1472. doi: 10.1111/j.1600-6143.2006.01320.x