Effect of severe diarrhoea on kidney transplant outcomes

Aim In addition to immunological complications, non-immunological events should be considered following kidney transplantation. Among them, diarrhoea is the most common gastrointestinal complication, but its effect on transplant outcomes remains unclear. Methods This retrospective study enrolled patients who underwent kidney transplantation between May 1993 and December 2017. Patients with diarrhoea as the chief complaint at admission were defined as the diarrhoea group. Transplant outcomes were compared between the diarrhoea and non-diarrhoea groups. Results Among a total of 1704 kidney recipients, severe diarrhoea that required hospitalization was identified in 84 (4.9%) patients. Patients with diarrhoea showed higher risks of graft failure (adjusted hazard ratio, 4.77 (2.98-7.64)) and all-cause mortality (adjusted hazard ratio, 7.17 (4.09-12.58)) than did patients without diarrhoea. The risk of de novo donor-specific antibody was also elevated in the diarrhoea group, although there was no change in the risk of biopsy-proven rejection. In subgroup analysis, the aetiology of diarrhoea, as well as a change in immunosuppressant following diarrhoea, showed no significant differences in graft survival. However, incomplete recovery from concurrent acute kidney injury was significantly associated with graft loss. Conclusion Diarrhoea is related to poor graft and patients' outcomes in kidney recipients. An effort to recover from concurrent acute kidney injury is important for improved graft survival.