总结肾移植围手术期腹泻发生特点、预后及危险因素，为预防或处理肾移植围手术期腹泻提供策略和依据。

回顾性分析浙江大学医学院附属第一医院360例肾移植受者临床资料，根据受者围手术期是否发生腹泻，分为腹泻组(n＝146)和非腹泻组(n＝214)。分析两组受者年龄、性别、移植类型、免疫诱导方案、CNI和霉酚酸(MPA)种类、预防感染方案和移植肾功能延迟恢复(DGF)发生情况对腹泻发生率的影响，以及腹泻发生时间、次数和病程、住院时间及出院时肾功能等。采用成组t检验比较正态分布计量资料。采用χ²检验比较计数资料。将单因素分析中P<0.10的因素纳入Logistic回归多因素分析。P<0.05为差异有统计学意义。

肾移植围手术期腹泻发生率为40.6%(146/360)，腹泻组受者腹泻发生时间为移植后(6±3)d，腹泻次数为(3.7±1.2)次/d，腹泻持续时间中位数为1.5 d，经对症治疗后均缓解。腹泻组与非腹泻组住院时间分别为(22±15)和(12±7)d，差异有统计学意义(t＝6.732，P<0.05)。腹泻组和非腹泻组受者出院时血清肌酐分别为(144±80)和(118±42)μmol/L，差异无统计学意义(t＝1.968，P>0.05)。单因素分析结果显示，两组受者年龄、供肾类型、免疫诱导方案、预防感染方案及DGF发生情况差异均有统计学意义(P均<0.05)，性别、CNI和MPA种类差异均无统计学意义(P均>0.05)。Logistic回归多因素分析结果显示，移植后发生DGF(OR＝4.647，95%可信区间：1.948～11.088)以及移植后使用不同的预防感染方案是肾移植受者围手术期发生腹泻的独立危险因素。与头孢呋辛相比，使用哌拉西林/他唑巴坦(OR＝5.749，95%可信区间：1.455～22.713)更易导致肾移植围手术期腹泻发生。

肾移植受者围手术期腹泻发生率较高，可导致住院时间延长，移植后出现DGF并使用特定的预防感染方案是其独立危险因素。

To summarize the incidence, prognosis and risk factors of perioperative diarrhea in renal transplantation, and to provide strategies and basis for the prevention or treatment of perioperative diarrhea in renal transplantation recipients.

The clinical data of 360 renal transplant recipients in the First Affiliated Hospital, Zhejiang University School of Medicine were analyzed retrospectively. The recipients were divided into diarrhea group (n=146) and the non-diarrhea group (n=214) according to whether perioperative diarrhea occurred. The clinical characteristics of the diarrhea group and the non-diarrhea group were compared, and the effects of recipient age, sex, transplantation type, immune induction regimen, CNI and mycophenolic acid (MPA) types, infection prevention regimen, and delayed graft function (DGF) occurrence on the incidence of diarrhea were analyzed. Measurement data with normal distribution were compared by group t test. Enumeration data were compared by the χ² test. Factors with P<0.10 in univariate analysis were included in multivariate logistic regression analysis. A P<0.05 was considered statistically significant.

The incidence of perioperative diarrhea was 40.6% (146/360). The occurrence time of diarrhea was (6±3) d (1-20 d), the frequency of diarrhea was (3.7±1.2) times/d (3-10 times/d), and the median duration of diarrhea was 1.5 d (1-18 d). All patients were relieved after symptomatic treatment. The hospital stays of diarrhea group and non-diarrhea group were (22±15) d and (12±7) d, respectively, and the difference had a statistical significance (t=6.732, P<0.05). Serum creatinine was (144±80) and (118±42) μmol/L in diarrhea and non-diarrhea recipients at discharge, respectively, and the difference was not statistically significant (t=1.968, P>0.05). The results of univariate analysis showed that there were significant differences in recipient age, donor kidney type, immunization induction regimen, infection prevention regimen and DGF occurrence between the diarrhea and non-diarrhea groups (all P<0.05), and there was no significant difference in sex, CNI and MPA types (all P>0.05). The results of Logistic multivariate analysis showed that the occurrence of DGF after transplantation (OR=4.647, 95% confidence interval: 1.948-11.088) and the use of different infection prevention regimens after transplantation were independent risk factors for perioperative diarrhea in renal transplant recipients. Compared with cefuroxime, recipients who used piperacillin/tazobactam (OR=5.749, 95% confidence interval: 1.455-22.713) were more likely to lead to perioperative diarrhea.

The incidence of perioperative diarrhea in renal transplant recipients is high, which can lead to prolonged hospital stay. DGF after transplantation and the use of specific infection prevention regimen are independent risk factors.