Diagnosis And Management Of Diarrhea In Solid‐Organ Transplant Recipients

Publication Date: April 1, 2019
Last Updated: March 14, 2022

Recommendations

EPIDEMIOLOGY AND ETIOLOGY OF DIARRHEA IN SOT RECIPIENTS

A detailed clinical history should be obtained on all SOT recipients presenting with diarrhea. (Moderate, Strong)
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Clinicians must have heightened suspicion for infection as a cause of diarrhea in SOT recipients. (Moderate, Strong)
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Clinicians should be aware of regional differences in the etiology of diarrhea in SOT recipients, and diagnostic and treatment strategies should be individualized for the specific practice region. (High, Strong)
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DIAGNOSTIC EVALUATION

Initial testing for SOT recipients with diarrhea should include testing for C. difficile and bacterial pathogens in the stool and CMV PCR testing in the serum. (Moderate, Strong)
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All patients with diarrhea should have their medications reviewed for potential causes of diarrhea and unnecessary agents should be stopped. (Moderate, Strong)
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SOT recipients with fever and bloody diarrhea should be evaluated for invasive enteropathogens and CMV. (Moderate, Strong)
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Persistent diarrhea should prompt testing for norovirus and parasitic causes for diarrhea. (Moderate, Strong)
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Colonoscopy with or without biopsy should be performed on SOT recipients with chronic diarrhea that have had a negative infectious evaluation or for those not responding to targeted therapy. (Moderate, Strong)
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If available, multiplex PCR testing for stool pathogens should be performed on all SOT recipients presenting with diarrhea.

(Moderate, Weak)
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TREATMENT

Empiric antimotility therapy should be considered in SOT recipients with diarrhea that is negative for C. difficile and where there is no evidence of megacolon or inflammatory diarrhea. (Moderate, Weak)
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SOT recipients with diarrhea and mild to moderate dehydration should be given reduced osmolarity rehydration fluids. (Moderate, Strong)
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Isotonic intravenous fluids should be administered for those with severe dehydration, shock, altered mental status, or ileus. (High, Strong)
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Antimicrobial therapy should be modified to target any identified pathogen suspected to be the cause of the diarrhea. (High, Strong)
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Recommendation Grading

Overview

Title

Diagnosis And Management Of Diarrhea In Solid‐Organ Transplant Recipients

Authoring Organization

American Society of Transplantation

Publication Month/Year

April 1, 2019

Last Updated Month/Year

January 30, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

These guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of diarrhea in the pre‐ and post‐transplant period.

Target Patient Population

Solid organ transplant patients

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D003967 - Diarrhea, D019072 - Antibiotic Prophylaxis, D014180 - Transplantation, D019737 - Transplants, D016377 - Organ Transplantation, D016360 - Clostridium difficile, D029322 - Norovirus

Keywords

diarrhea, Clostridium difficile, infection, solid organ transplant, antimicrobial, norovirus

Source Citation

Angarone, M, Snydman, DR; on behalf of the AST ID Community of Practice. Diagnosis and management of diarrhea in solid‐organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33:e13550.