Etiology and Management of Diarrhea after Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Yanming , YANG Jiamei

Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China;

Corresponding author：

Keywords：

Diarrhea; Liver transplantation

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Objective 　To review the recent studies regarding etiology and management of diarrhea after liver transplantation.
Methods 　The current related literatures about the etiology and management of diarrhea after liver transplantation were reviewed.
Results 　There were approximately 10.00% to 35.44% recipients developed diarrhea after liver transplantation. Other symptoms such as severe body fluid and electrolyte loss, discomfort, and increase blood level of immunosuppressive drug can be caused by diarrhea as well. Clostridium difficile, cytomegalovirus, rotavirus infection and immunosuppressant were main etiological factors. It is important to find out the inducement of diarrhea and work out the corresponding management and other supportive care on the basis of the etiology.
Conclusion 　Diarrhea is a common complication of liver transplantation whose etiology is complex. Appropriate approaches may be helpful to decrease the risk of this complication.

Citation： ZHOU Yanming,YANG Jiamei. Etiology and Management of Diarrhea after Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(2): 155-158. doi: Copy

1.	Wong NA, Bathgate AJ, Bellamy CO. Colorectal disease in liver allograft recipients——a clinicopathological study with follow-up [J]. Eur J Gastroenterol Hepatol, 2002; 14(3)∶231.
2.	张红霞, 陈琪尔, 陈利芬, 等. 28例肝移植术后患者腹泻的相关因素分析及护理 [J]. 中华护理杂志, 2005; 40(4)∶275.
3.	Matsui A, Arakawa Y, Momoya T, et al. Apparently increased trough levels of tacrolimus caused by acute infantile diarrhea in two infants with biliary atresia after liver transplantation [J]. Acta Paediatr Jpn, 1996; 38(6)∶699.
4.	Stelzmueller I, Dunst KM, Hengster P, et al. A cluster of rotavirus enteritis in adult transplant recipients [J]. Transpl Int, 2005; 18(4)∶470.
5.	Maezono S, Sugimoto K, Sakamoto K, et al. Elevated blood concentrations of calcineurin inhibitors during diarrheal episode in pediatric liver transplant recipients: involvement of the suppression of intestinal cytochrome P450 3A and P-glycoprotein [J]. Pediatr Transplant, 2005; 9(3)∶315.
6.	Fruhwirth M, Fischer H, Simma B, et al. Rotavirus infection as cause of tacrolimus elevation in solid-organ-transplanted children [J]. Pediatr Transplant, 2001; 5(2)∶88.
7.	Teisseyre J, Teisseyre M, Kalicinski P, et al. Elevated tacrolimus levels during diarrhea in children after liver transplantation [J]. Transplant Proc, 2003; 35(6)∶2292.
8.	Singh N, Wannstedt C, Keyes L, et al. Indirect outcomes associated with cytomegalovirus (opportunistic infections, hepatitis C virus sequelae, and mortality) in liver-transplant recipients with the use of preemptive therapy for 13 years [J]. Transplantation， 2005; 79(10)∶1428.
9.	彭勇, 龚建平, 严律南. 肝移植后巨细胞病毒感染 [J]. 中国普外基础与临床杂志, 2004; 11(5)∶409.
10.	傅卫, 袁炯, 宋世兵, 等. 肝移植病人术后巨细胞病毒感染的预防和治疗 [J]. 中华肝胆外科杂志, 2003; 9(5)∶287.
11.	Gane E, Saliba F, Valdecasas GJ, et al. Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. The Oral Ganciclovir International Transplantation Study Group [corrected] [J]. Lancet, 1997; 350(9093)∶1729.
12.	肖卫东, 彭承宏, 周光文, 等. 肝移植术后巨细胞病毒再感染的预防与治疗 [J]. 中华器官移植杂志, 2005; 6(3)∶139.
13.	Palau LA, Kemmerly SA. First report of invasive amebiasis in an organ transplant recipient [J]. Transplantation, 1997; 64(6)∶936.
14.	Gerber DA, Green M, Jaffe R, et al. Cryptosporidial infections after solid organ transplantation in children [J]. Pediatr Transplant, 2000; 4(1)∶50.
15.	Goetz M, Eichenlaub S, Pape GR, et al. Chronic diarrhea as a result of intestinal microsposidiosis in a liver transplant recipient [J]. Transplantation, 2001; 71(2)∶334.
16.	Koch RO, Graziadei IW, Schulz F, et al. Long-term efficacy and safety of mycophenolate mofetil in liver transplant recipients with calcineurin inhibitor-induced renal dysfunction [J]. Transpl Int, 2004; 17(9)∶518.
17.	Wiesner R, Rabkin J, Klintmalm G, et al. A randomized double-blind comparative study of mycophenolate mofetil and azathioprine in combination with cyclosporine and corticosteroids in primary liver transplant recipients [J]. Liver Transpl, 2001; 7(5)∶442.
18.	Pierini A, Mirabella S, Brunati A, et al. Mycophenolate mofetil monotherapy in liver transplantation [J]. Transplant Proc, 2005; 37(6)∶2614.
19.	Moreno Planas JM, Cuervas-Mons Martinez V, Rubio Gonzalez E, et al. Mycophenolate mofetil can be used as monotherapy late after liver transplantation [J]. Am J Transplant, 2004; 4(10)∶1650.
20.	A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation. The U.S. Multicenter FK506 Liver Study Group [J]. N Engl J Med, 1994; 331(17)∶1110.
21.	Levy G, Villamil F, Samuel D, et al. Results of lis2t, a multicenter, randomized study comparing cyclosporine microemulsion with C2 monitoring and tacrolimus with C0 monitoring in de novo liver transplantation [J]. Transplantation, 2004; 77(11)∶1632.
22.	Jimenez-Rivera C, Avitzur Y, Fecteau AH, et al. Sirolimus for pediatric liver transplant recipients with post-transplant lymphoproliferative disease and hepatoblastoma [J]. Pediatr Transplant, 2004; 8(3)∶243.
23.	Smith DM, Agura E, Netto G, et al. Liver transplant-associated graft-versus-host disease [J]. Transplantation, 2003; 75(1)∶118.
24.	Jain A, Nalesnik M, Reyes J, et al. Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience [J]. Ann Surg, 2002; 236(4)∶429.
25.	Younes BS, Ament ME, McDiarmid SV, et al. The involvement of the gastrointestinal tract in posttransplant lymphoproliferative disease in pediatric liver transplantation [J]. J Pediatr Gastroenterol Nutr, 1999; 28(4)∶380.
26.	辛华雯. CYP3A4和P糖蛋白与药物的肠道处置 [J]. 中国临床药理学与治疗学, 2005; 10(7)∶721.

1. 　Wong NA, Bathgate AJ, Bellamy CO. Colorectal disease in liver allograft recipients——a clinicopathological study with follow-up [J]. Eur J Gastroenterol Hepatol, 2002; 14(3)∶231.
2. 　张红霞, 陈琪尔, 陈利芬, 等. 28例肝移植术后患者腹泻的相关因素分析及护理 [J]. 中华护理杂志, 2005; 40(4)∶275.
3. 　Matsui A, Arakawa Y, Momoya T, et al. Apparently increased trough levels of tacrolimus caused by acute infantile diarrhea in two infants with biliary atresia after liver transplantation [J]. Acta Paediatr Jpn, 1996; 38(6)∶699.
4. 　Stelzmueller I, Dunst KM, Hengster P, et al. A cluster of rotavirus enteritis in adult transplant recipients [J]. Transpl Int, 2005; 18(4)∶470.
5. 　Maezono S, Sugimoto K, Sakamoto K, et al. Elevated blood concentrations of calcineurin inhibitors during diarrheal episode in pediatric liver transplant recipients: involvement of the suppression of intestinal cytochrome P450 3A and P-glycoprotein [J]. Pediatr Transplant, 2005; 9(3)∶315.
6. 　Fruhwirth M, Fischer H, Simma B, et al. Rotavirus infection as cause of tacrolimus elevation in solid-organ-transplanted children [J]. Pediatr Transplant, 2001; 5(2)∶88.
7. 　Teisseyre J, Teisseyre M, Kalicinski P, et al. Elevated tacrolimus levels during diarrhea in children after liver transplantation [J]. Transplant Proc, 2003; 35(6)∶2292.
8. 　Singh N, Wannstedt C, Keyes L, et al. Indirect outcomes associated with cytomegalovirus (opportunistic infections, hepatitis C virus sequelae, and mortality) in liver-transplant recipients with the use of preemptive therapy for 13 years [J]. Transplantation， 2005; 79(10)∶1428.
9. 　彭勇, 龚建平, 严律南. 肝移植后巨细胞病毒感染 [J]. 中国普外基础与临床杂志, 2004; 11(5)∶409.
10. 　傅卫, 袁炯, 宋世兵, 等. 肝移植病人术后巨细胞病毒感染的预防和治疗 [J]. 中华肝胆外科杂志, 2003; 9(5)∶287.
11. 　Gane E, Saliba F, Valdecasas GJ, et al. Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. The Oral Ganciclovir International Transplantation Study Group [corrected] [J]. Lancet, 1997; 350(9093)∶1729.
12. 　肖卫东, 彭承宏, 周光文, 等. 肝移植术后巨细胞病毒再感染的预防与治疗 [J]. 中华器官移植杂志, 2005; 6(3)∶139.
13. 　Palau LA, Kemmerly SA. First report of invasive amebiasis in an organ transplant recipient [J]. Transplantation, 1997; 64(6)∶936.
14. 　Gerber DA, Green M, Jaffe R, et al. Cryptosporidial infections after solid organ transplantation in children [J]. Pediatr Transplant, 2000; 4(1)∶50.
15. 　Goetz M, Eichenlaub S, Pape GR, et al. Chronic diarrhea as a result of intestinal microsposidiosis in a liver transplant recipient [J]. Transplantation, 2001; 71(2)∶334.
16. 　Koch RO, Graziadei IW, Schulz F, et al. Long-term efficacy and safety of mycophenolate mofetil in liver transplant recipients with calcineurin inhibitor-induced renal dysfunction [J]. Transpl Int, 2004; 17(9)∶518.
17. 　Wiesner R, Rabkin J, Klintmalm G, et al. A randomized double-blind comparative study of mycophenolate mofetil and azathioprine in combination with cyclosporine and corticosteroids in primary liver transplant recipients [J]. Liver Transpl, 2001; 7(5)∶442.
18. 　Pierini A, Mirabella S, Brunati A, et al. Mycophenolate mofetil monotherapy in liver transplantation [J]. Transplant Proc, 2005; 37(6)∶2614.
19. 　Moreno Planas JM, Cuervas-Mons Martinez V, Rubio Gonzalez E, et al. Mycophenolate mofetil can be used as monotherapy late after liver transplantation [J]. Am J Transplant, 2004; 4(10)∶1650.
20. 　A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation. The U.S. Multicenter FK506 Liver Study Group [J]. N Engl J Med, 1994; 331(17)∶1110.
21. 　Levy G, Villamil F, Samuel D, et al. Results of lis2t, a multicenter, randomized study comparing cyclosporine microemulsion with C2 monitoring and tacrolimus with C0 monitoring in de novo liver transplantation [J]. Transplantation, 2004; 77(11)∶1632.
22. 　Jimenez-Rivera C, Avitzur Y, Fecteau AH, et al. Sirolimus for pediatric liver transplant recipients with post-transplant lymphoproliferative disease and hepatoblastoma [J]. Pediatr Transplant, 2004; 8(3)∶243.
23. 　Smith DM, Agura E, Netto G, et al. Liver transplant-associated graft-versus-host disease [J]. Transplantation, 2003; 75(1)∶118.
24. 　Jain A, Nalesnik M, Reyes J, et al. Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience [J]. Ann Surg, 2002; 236(4)∶429.
25. 　Younes BS, Ament ME, McDiarmid SV, et al. The involvement of the gastrointestinal tract in posttransplant lymphoproliferative disease in pediatric liver transplantation [J]. J Pediatr Gastroenterol Nutr, 1999; 28(4)∶380.
26. 　辛华雯. CYP3A4和P糖蛋白与药物的肠道处置 [J]. 中国临床药理学与治疗学, 2005; 10(7)∶721.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Etiology and Management of Diarrhea after Liver Transplantation

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