Early ileocolonoscopy with biopsy for the evaluation of persistent post-transplantation diarrhea

Table 1 Clinical and demographic characteristics of the study population¹

	Total	Drug	Infection	Non-drug, non-infectious2	P3
No. of cases of persistent diarrhea	30	10	11	9
Gender, n (%)
Female	8 (26.7)	3 (30)	2 (18.2)	3 (33.3)
Male	22 (73.3)	7 (70)	9 (81.8)	6 (66.7)
Donor type
Cadaveric	43.3	60	27.3	44.4
Living	56.7	40	72.7	55.6	NS
Age at diarrheal episode (yr), mean ± SD (range)	51.4 ± 15.5 (24-76)	46.9 ± 17.1 (27-76)	52.6 ± 10 (40-70)	54.8 ± 19.4 (24-75)	NS
History of previous diarrheal episode, n (%)	21 (70)	4 (40)	9 (81.8)	8 (89)	0.081
Time since transplantation (mo), mean ± SD (range)	62.3 ± 53.2 (1-199)	40.5 ± 44.8 (1-142)	85.5 ± 47.6 (2-179)	58.1 ± 61.8 (6-199)	0.038
Immunosuppressive regimen4, n (%)
Mycophenolate mofetil + tacrolimus	18 (60)	6 (60)	6 (54.5)
Mycophenolate mofetil + cyclosporine	2 (6.6)		1 (9.1)
Mycophenolate mofetil + sirolimus	2 (6.6)	1 (10)	1 (9.1)
Mycophenolate mofetil + everolimus	1 (3.3)	1 (10)
Everolimus + tacrolimus	2 (6.6)		2 (18.2)
Tacrolimus	2 (6.6)
Mycophenolate sodium + tacrolimus	3 (10)	2 (20)	1 (9.1)
Hospital stay (d), mean ± SD (range)	18.1 ± 30.6 (0-169)	8.5 ± 8.5 (0-22)	17.4 ± 11.6 (0-37)	29.4 ± 53.8 (0-169)	0.076
Outcome, n (%)
Cessation of diarrhea	22 (73.3)	9 (90)	9 (82)	4 (44.4)	NS
Improvement	5 (16.7)			5 (55.6)
Death/graft loss	3 (10)	1 (10)	2 (18)

¹Data are presented per episode of persistent diarrhea;

²Other and unknown groups combined;

³Comparison between infectious and drug-induced cases of persistent diarrhea;

⁴All patients were taking methylprednisolone at the time of persistent diarrhea. NS: Not significant.

Table 2 Endoscopic¹ and histological² findings in renal transplant patients with persistent diarrhea

Cases	Endoscopy + histology +	Endoscopy + histology -	Endoscopy - histology +	Endoscopy - histology -
All	16	3	9	2
Drug-induced	4		6
Infectious	7	13	3
Other	3
No diagnosis4	2	2	0	2

¹Ileocolonoscopy;

²Including biopsies from normal-looking mucosa;

³In this case biopsy was not taken because of typical pseudomembranous colitis in endoscopy;

⁴Including cases with non-specific colitis in endoscopy or histology.